Early small bowel obstruction after laparoscopic gastric bypass: a surgical emergency

Khoraki, Jad; Mazzini, Guilherme S.; Shah, Amar; Prado, Paul A. R. Del; Wolfe, Luke; Campos, Guilherme M.

doi:10.1016/j.soard.2018.05.009

Cited by 26 publications

(27 citation statements)

References 22 publications

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“…Considering reoperation is a risk for SBO presentation because of a higher chance of adhesion formation or changing the anatomy, readmission and reoperation are more common in patients who underwent revisional procedures [9] . Several reports demonstrated different causes of SBO after revisional surgery, including internal hernias, adhesions, kinking, or narrowing of anastomosis [10] , [11] , [12] , [13] . Although consequences and presentations of symptomatic CC are documented in the literature, to our knowledge, no report mentioned CC causing SBO post-LGB.…”

Section: Discussionmentioning

confidence: 99%

Candy cane syndrome at jejunojejunostomy causing small bowel obstruction following revisional laparoscopic gastric bypass: A case report and review of literature

Almayouf

Billa²,

Alqahtani

2021

International Journal of Surgery Case Reports

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Introduction and importance The literature described Candy cane syndrome (CCS) as causing various symptoms and affecting patients' quality of life. Most of the literature described this syndrome occurrence at gastrojejunostomy (GJ) anastomosis. The literature lacks data on this syndrome occurring at the jejunojejunostomy (JJ). Case presentation We describe a patient who underwent revision of laparoscopic gastric bypass (LGB) due to weight regain and presented three days after the procedure with small bowel obstruction (SBO). The patient was admitted as she demonstrated a picture of SBO. A complete workup and contrast study was done and showed dilated bowel loops. The patient was taken for exploratory laparoscopy, which revealed dilated 10–15 cm candy cane near the JJ, causing and obstruction. Resection of the elongated blind pouch was done, and the patient tolerated the surgery with improvement in her symptoms. Preoperative imaging, perioperative management, procedure videos, and follow-up were used to describe the case. Clinical discussion After reviewing the literature, eight papers reported CCS, 7 of those articles mentioned the syndrome located at the GJ. CCS located near the JJ can lead to symptoms including SBO. Management is mainly surgical, and prevention of occurrence can be achieved by limiting unnecessary elongated blind pouches. Conclusion CCS is a well-established condition occurring at the GJ following LGB, but it can manifest similarly if an elongated blind limb is left unresected at the JJ.

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Section: Discussionmentioning

confidence: 99%

Candy cane syndrome at jejunojejunostomy causing small bowel obstruction following revisional laparoscopic gastric bypass: A case report and review of literature

Almayouf

Billa²,

Alqahtani

2021

International Journal of Surgery Case Reports

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“…4,13,14 The development of an intraluminal blood clot causing an ESBO is a rare complication after LRYGB, with only a few cases reported so far, mainly represented by single case reports. 4,8,9,[13][14][15][16][17][18][19] To date, only 10 papers encompassing a total of 23 patients, have been published. 4,8,9,14,18,19 Data about these studies are summarized in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,9,[13][14][15][16][17][18][19] To date, only 10 papers encompassing a total of 23 patients, have been published. 4,8,9,14,18,19 Data about these studies are summarized in Table 3. In these published papers, the incidence of hemobezoar ranges between 0.05% and 1.9%.…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction After Laparoscopic Roux-en-Y Gastric Bypass Caused by Hemobezoar: A Case Series and Review of Literature

Caputo¹,

Facchiano²,

Soricelli³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The development of an intraluminal blood clot (hemobezoar), represents a rare cause (0.05% to 1.9%) of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB). We present a case series of 6 cases of SBO caused by hemobezoar.Methods: A retrospective analysis of a prospective database including patients who underwent LRYGB from January 2010 to December 2019 has been performed. All the patients who underwent reoperation because of an SBO caused by an intraluminal blood clot were included in the present study.Results: Six of 843 LRYGB patients developed an hemobezoar (0.71%). Primary LRYGB was uneventful in all cases. SBO symptoms developed after a mean interval of 26.6 hours from the primary procedure. All reoperations were performed with the laparoscopic approach. In all cases, the hemobezoar was located at the level of the jejunojejunal anastomosis (JJA) and was removed through an enterotomy performed at the distal end of the biliopancreatic stump. Three postoperative complications occurred: 1 ab-ingestis pneumonia, 1 leak of the JJA requiring further reoperation, and 1 pelvic abscess treated with radiologic drainage. The mean hospital stay was 11 days.Discussion: SBO due to hemobezoar is a rare but worrisome early complication after LRYGB. It almost always affects the JJA and requires a prompt diagnosis to avoid dreadful sequelae. In the absence of anastomotic leak or stenosis, surgical management may consist of the removal of the blood clot without refashioning the anastomosis and it may be accomplished with the laparoscopic approach.

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“…Early obstruction after RYGB (< 30 days) occurs in 0.5%-1.7% of patients [50][51][52] , with an overall incidence around 3%-4.4% [48][49][50][51][53][54][55][56] . The most common site of early obstruction is at the jejunojejunostomy, usually due to kinking or narrowing of the anastomosis.…”

Section: Obstruction/internal Herniamentioning

confidence: 99%

“…Internal hernias should be reduced, bowel resected if non-viable, and defects closed if present. If there is significant dilation of the biliopancreatic limb or gastric remnant, placement of a decompressive gastrostomy tube within the gastric remnant should be considered [50,51] . Finally, there should be a low threshold to perform a diagnostic laparoscopy in patients with intermittent or chronic abdominal pain after RYGB, as internal herniation could be the underlying cause, even in the absence of CT findings.…”

Section: Obstruction/internal Herniamentioning

confidence: 99%

Revisional bariatric surgery: a review of workup and management of common complications after bariatric surgery

Lyons¹,

Omar²,

Tholey³

et al. 2022

MIS

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With the rising prevalence of obesity, there has been a steady rise in the number of bariatric surgeries performed worldwide. As expected, there has also been an increase in the number of revisional surgeries performed to manage acute and chronic postoperative complications. This review will discuss the major complications that can arise from the most common bariatric surgeries, their diagnosis, medical management, and potential revisional surgical options.

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Early small bowel obstruction after laparoscopic gastric bypass: a surgical emergency

Cited by 26 publications

References 22 publications

Candy cane syndrome at jejunojejunostomy causing small bowel obstruction following revisional laparoscopic gastric bypass: A case report and review of literature

Candy cane syndrome at jejunojejunostomy causing small bowel obstruction following revisional laparoscopic gastric bypass: A case report and review of literature

Small Bowel Obstruction After Laparoscopic Roux-en-Y Gastric Bypass Caused by Hemobezoar: A Case Series and Review of Literature

Revisional bariatric surgery: a review of workup and management of common complications after bariatric surgery

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