caa a22 4500 467954216 CHVBK 20180405193745.0 cr unu---uuuuu 170328e20041101xx s 000 0 eng 10.1007/BF02637134 doi (NATIONALLICENCE)springer-10.1007/BF02637134 (NATIONALLICENCE)springer-10.1007/s00464-004-8804-2 Causes of small bowel obstruction after laparoscopic gastric bypass [Elektronische Daten] [R. Hwang, D. Swartz, E. Felix] Background: Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass is not a rare complication, occurring in approximately 3% of patients. The goal of this study was to review the causes and timing of small bowel obstruction as an aid to diagnosis, treatment, and prevention. Methods: The records of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass at the authors' center from 4/99 to 7/03 were retrospectively reviewed. All the patients had a laparoscopic handsewn gastrojejunostomy and a stapled jejunojej-unostomy. The Roux limb was placed retrocolically in the first 405 patients and antecolically in the next 1,310 patients. Results: Altogether, 1,715 patients underwent a total laparoscopic Roux-en-Y gastric bypass at the authors' bariatric center. In 51 patients, 55 small bowel obstructions occurred (3%) during a median follow-up period of 21 months (range 1-52 months). Small bowel obstruction developed in 27 (7%) of the retrocolic patients, as compared with 24 (2%) of the antecolic patients (p<0.001, chi-square). The cause of small bowel obstruction were adhesive bands (n=14), obstruction at the jejunojejunostomy from kinking or narrowing (n=13), internal hernia or external compression at the transverse mesocolon (n=11), internal hernia through the jejunal mesentery (n=8) incarcerated abdominal wall hernia (n=4), and other (n=5). For patients in whom small bowel obstruction developed in the first 3 weeks after their bypass surgery bowel resection was required in 19 of 24 patients, as compared with 6 of 31 patients in whom obstruction develop after 3 weeks (p<0.001, chi-square). Conclusions: Early small bowel obstructions tend to result from technical problems with the Roux limb and require revision of the bypass or small bowel resection significantly more often than late obstructions. The latter group of obstructions usually result from adhesions or hernias, which could be handled laparoscopically without bowel resection. The position of the Roux limb (retrocolic vs antecolic) appeared to influence the incidence of small bowel obstruction. In the current series, changing the position of the jejunal bypass limb from retrocolic to antecolic significantly decreased the overall incidence of small bowel obstruction because it eliminated one of the most common sites for obstruction: the mesocolon. Springer Science+Business Media, Inc, 2004 Morbid obesity nationallicence Bariatric surgery nationallicence Laparoscopic gastric bypass nationallicence Small bowel obstruction nationallicence Internal hernias nationallicence Hwang R. Advanced Bariatric Center, 6107 North Fresno, Suite 102, Fresno, CA, USA aut Swartz D. Advanced Bariatric Center, 6107 North Fresno, Suite 102, Fresno, CA, USA aut Felix E. Advanced Bariatric Center, 6107 North Fresno, Suite 102, Fresno, CA, USA aut Surgical Endoscopy And Other Interventional Techniques Springer-Verlag 18/11(2004-11-01), 1631-1635 0930-2794 18:11<1631 2004 18 464 https://doi.org/10.1007/BF02637134 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02637134 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hwang R. Advanced Bariatric Center, 6107 North Fresno, Suite 102, Fresno, CA, USA aut NATIONALLICENCE 700 1- Swartz D. Advanced Bariatric Center, 6107 North Fresno, Suite 102, Fresno, CA, USA aut NATIONALLICENCE 700 1- Felix E. Advanced Bariatric Center, 6107 North Fresno, Suite 102, Fresno, CA, USA aut NATIONALLICENCE 773 0- Surgical Endoscopy And Other Interventional Techniques Springer-Verlag 18/11(2004-11-01), 1631-1635 0930-2794 18:11<1631 2004 18 464 NATIONALLICENCE 856 40 https://doi.org/10.1007/s00464-004-8804-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hwang R. Advanced Bariatric Center, 6107N. Fresno, Suite 102, Fresno, California, USA aut NATIONALLICENCE 700 1- Swartz D. Advanced Bariatric Center, 6107N. Fresno, Suite 102, Fresno, California, USA aut NATIONALLICENCE 700 1- Felix E. Advanced Bariatric Center, 6107N. Fresno, Suite 102, Fresno, California, USA aut NATIONALLICENCE 773 0- Surgical Endoscopy And Other Interventional Techniques Springer-Verlag; www.springer-ny.com 18/11(2004-11-01), 1631-1635 0930-2794 18:11<1631 2004 18 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE NATIONALLICENCE NL-springer