Georgios Orthopoulos, MD, PhD, Heather Grant, MD, Parth Sharma, MD, Erin Thompson, MD, John Romanelli, MD. Baystate Medical Center/University of Massachusetts Medical School
Introduction: Jejunojejunal intussusception after Roux-en-Y gastric bypass for morbid obesity is a rare but potentially catastrophic complication of this type of bariatric procedure. There are limited data regarding the incidence of intussusception and the different surgical options for management of this disease.
Methods: This is a retrospective review of all patients that underwent Roux-en-Y gastric bypass (RNYGBP) for morbid obesity and subsequently developed intussusception at the jejunojejunostomy. Data were collected between 1/1/2008 and 6/30/2018 and included demographics, details related to the index procedure (operative approach, construction of Roux limb and jejunojejunostomy), presentation and management of intussusception. Perioperative outcomes and complications were also collected.
Results: A total of 575 patients underwent RNYGBP from 1/1/2008 until 6/30/2018. 35 patients (6.1%) developed intussusception. Demographics included age, gender and BMI at both the index surgery and at the time of intussusception. 30 patients (85.7%) had undergone laparoscopic RNYGBP. The jejunojejunostomy was created during the index procedure using a linear stapler in all patients of our study population with 48.6% achieving a length of 90mm. 31 patients presented acutely with abdominal pain and 24 (68.6%) had radiologic findings of intussusception. All but one patient required surgical intervention and in 88.6% the procedure to address the intussusception was completed laparoscopically. Intraoperative findings of intussusception were noted in 44.1% of the patients and in the majority of the patients (80%), it was retrograde. Reduction and enteropexy or just enteropexy was performed in 21 patients (61.8%) that required surgery. No complications were noted after the procedure but 9 patients (25.7%) had recurrence of intussusception requiring another surgical intervention during their follow up. In the reoperated group, intraoperative intussusception was noted in 4 patients (44.4%), was retrograde in 44.4% and 77.7% was treated with reduction and enteropexy or just enteropexy.
Conclusion: This is the largest case series describing jejunojejunal intussusception in Roux-en-Y gastric bypass patients. The jejunojejunostomy during the index surgery was constructed with a length of 60mm or 90mm in 71.4% of our study population and the most common surgical repair of choice was either reduction and enteropexy or enteropexy alone. These findings suggest that length of the jejunojejunostomy greater than 45mm might be associated with the occurrence of intussusception and could explain the higher incidence noted in our series. Minimal intervention with enteropexy can offer effective treatment for most patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95055
Program Number: S054
Presentation Session: Bariatric I – Complications
Presentation Type: Podium