Surgical Management of Chronic Abdominal Pain After Laparoscopic Roux-en-Y Gastric Bypass.

Background:
Chronic abdominal pain after gastric bypass can be elusive to most diagnosis modalities, requiring in many cases diagnostic laparoscopy. In this video, we present the surgical management of a patient with chronic abdominal pain two years after laparoscopic Roux-en-Y Gastric Bypass (LRYGB).

Case report:
A 20 year old female underwent a LRYGB three years ago. She was progressing well for the first 24 months, then developed abdominal pain. After which, the patient underwent four diagnostic laparoscopies for the same pain in a period of 8 months. All procedures revealed either adhesion or internal hernias that where closed. The patient then came to our institution for a second opinion. An upper gastrointestinal study demonstrated a large and non emptying pouch after 30 minutes of PO barium. The patient was taken to the operating room. During the procedure she was found to have a dilated pouch as well as a large jejunal blind end at the gastro-jejunostomy, a jejunal diverticulum at the jejunojejunostomy site, a mesenteric defect at the jejunojejunostomy anastomosis and a dense adhesion from the distal jejunum to the posterior abdominal wall with herniated small bowel; all of which where corrected.

Results:
The patient tolerated the procedure well and on postoperative visits asserts resolution of her abdominal pain.

Conclusion:
Diagnostic laparoscopy is the most sensitive diagnosis tool for abdominal pain. The etiology of the pain may be still unclear in the operating room. It is sometimes prudent to correct all plausible causes of pain to prevent further trips to the operating table.

Session: Video Channel

Program Number: V074