Background

Early small bowel obstruction (ESBO, within 30 days of surgery) after laparoscopic gastric bypass (LRYGB) is reported infrequently (0.5‐5.2%), but it is associated with significant morbidity and treatment is not standardized. Our aim was to review prevalence, causes, associated factors, management, and outcomes of all patients treated for ESBO after LRYGB at a tertiary academic medical center.

Methods

Retrospective review of prospectively maintained data to identify consecutive patients who underwent primary LRYGB and those that developed ESBO from January 2000 through December 2016. Collected data were demographics, comorbidities, LRYGB technical details; and ESBO clinical presentation, location, causes, type of treatment and outcomes.

Results

1,703 patients (84% females) had LRYGB. Mean age and BMI were 42.3±11.1 years and 48.2±7.3 kg/m2, respectively. Comorbidities were frequent: type 2 diabetes (28%), hypertension (54%), obstructive sleep apnea (37%), hyperlipidemia (44%) and GERD (63%). The alimentary limb was antecolic in 426 patients (25%) and retrocolic in 1,277 (75%). 26 patients (1.5%) had ESBO. There were no demographic or technique details associated with ESBO, including alimentary limb position. All patients presented with symptoms, most commonly vomiting (n=13), on average 6.4±6.2 (range 1‐26) days postoperatively. In all cases, upper GI and/or computed tomography confirmed the diagnosis. Majority required re‐operation (n=20, 77%; 9 completed laparoscopically). Mean time from diagnosis to reoperation was 0.7±1.4 day (75% done on the same day, N=15), however, time from symptom to diagnosis varied significantly. Location and causes of ESBO are in Table 1.There was no difference in the location of obstruction [jejunojejunostomy (JJ) vs. others] between patients who had antecolic versus retrocolic technique. Obstruction at JJ was treated with reoperation in 13 patients (68%), using JJ bypass (n=7), complete JJ revision (n=4), decompression only (n=2). Obstruction other than at JJ was always treated with reoperation. Three patients (11.5%) developed an anastomotic leak and 2 died (7.7%).

Conclusions

ESBO occurs infrequently after LRYGB, most causes are technique related and preventable; however, it is associated with significant morbidity and mortality. A high index of clinical suspicion, rapid appropriate imaging, and prompt operative intervention are recommended.