Laparoscopic Resection of an Occluded Roux Limb

LAPAROSCOPICRESECTIONOF AN OCCLUDEDROUXLIMB

Allocco, Frances MD; Reardon, Patrick MD; Dunkin, Brian MD; Saad, Mohamed MD

The purpose of of our video is to present a patient who had a laparoscopic roux-en-Y gastric bypass, who years later developed occlusion of her roux limb. This is demonstrated endoscopically and was repaired laparoscopically.

The patient is a 38 year old woman with a history of a laparoscopic roux-en-Y gastric bypass. She presented seven years later with nausea and vomiting. She had an open internal hernia repair at an outside hospital, but her symptoms persisted. She was treated by the author, with a laparoscopic lysis of adhesions. Following that surgery, her symptoms persisted. Preoperative endoscopy revealed severe ulceration with complete obstruction of the roux limb.

We performed intraoperative endoscopy to confirm this and laparoscopically resected the occluded portion of the roux limb. We reanastomosed the distal end of the remaining roux limb distal to the previous jejunojejunostomy.

In follow-up, the patient has done well and is tolerating a diet without any problems.

This is a first report of an occluded roux limb after roux-en-Y gastric bypass. Bowel obstruction after gastric bypass has many etiologies, including internal hernias and adhesions, both of which this patient was surgically treated for. Obstruction may occur early or late. This patient presented years later with a complete obstruction of her roux limb from severe ulceration. Most ulcers in gastric bypass patients are marginal ulcers at the gastrojejunostomy and usually do not present years later. These can often be treated medically with proton pump inhibitors. If stenosis develops, it may be able to be managed endoscopically by dilation. Here endoscopy served as a helpful diagnostic tool and confirmed the location of the segment of bowel which we removed laparoscopically.


Session: Podium Video Presentation

Program Number: V030

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