Brandon W Vanderwel, MD, Kevin M Reavis, MD, Jan C Jay, MD, Valerie J Halpin, MD. Legacy Good Samaritan Medical Center
Background: Roux-en-y gastric bypass is a proven therapeutic treatment for metabolic diseases and morbid obesity. Internal hernias as a cause of bowel obstruction after roux-en-y have been extensively studied and surgical techniques have been developed to reduce their incidence. There is a paucity of data, however, about the incidence and etiology of non-internal hernia bowel obstructions (NIHBO).
Methods: A retrospective review of our institutional MBSAQIP database from 01/01/2015 – 08/01/2018 was used to identify NIHBO after roux-en-y gastric bypass. PHI was de-identified and data about patient characteristics, comorbidities, and clinical course were collected from the medical record.
Results: Twenty patients were identified as meeting the eligibility criteria for NIHBO after roux-en-y gastric bypass. Each patient that experienced a NIHBO was categorized by etiology: intraluminal hemorrhage (10%), technical (20%), unclear etiology (20%), food bezoar (20%), and adhesive disease (30%). Intraluminal hemorrhage as a source of obstruction presented within 1-2 days after surgery and were operatively managed to resolve the hemorrhage. All technical obstructions presented within 5 days of discharge (average post operative day 4) and were successfully treated with an operation, where a clear technical issue was identified and corrected. Patients with unclear etiology of obstruction presented within 2-7 days after surgery (average post operative day 4) and all were successfully managed with supportive care. All food bezoar obstructions presented within 30 days of discharge (average post operative day 8) and all were successfully treated with nonoperative management. Adhesive obstructions presented within a range of 3-75 days after discharge (average post operative day 26) and all were treated with an operation. There were no mortalities.
Conclusion: There are a variety of causes of post operative bowel obstruction after roux-en-y gastric bypass. Technical, bleeding, and adhesive disorders are successfully managed with surgery. Dietary causes can be managed nonoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95888
Program Number: P128
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster