Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the most common surgical treatment for morbid obesity. Intestinal obstruction and internal hernias are complications more commonly observed after LRYGB than after open RYGB. The aim of this study was to evaluate the incidence of these complications in patients who had undergone LRYGB using an antecolic versus a retrocolic technique.

METHODS: From August 2001 to August 2005, LRYGB was performed in 754 patients. The retrocolic and antecolic technique was used in 300 and 454 consecutive patients, respectively. The mean patient age was 37 +/- 10 years, and 552 of the patients (73%) were women. The mean preoperative body mass index was 41.3 +/- 5 kg/m2. The median follow-up was 16 months.

RESULTS: During follow-up, 36 patients (4.7%) underwent surgical exploration secondary to intestinal obstruction. This complication was observed in 28 (9.3%) and 8 (1.8%) patients in the retrocolic and antecolic technique groups, respectively (P <.001). In the retrocolic technique group, an internal hernia developed in 24 patients compared with 3 patients in the antecolic technique group. On multivariate analysis, the retrocolic technique was identified as a risk factor (P <.001).

CONCLUSION: A greater incidence of intestinal obstruction and internal hernia was observed in the retrocolic technique group than in the antecolic technique group undergoing LRYGB. The results of our study have shown that the use of the retrocolic technique is a risk factor for intestinal obstruction after LRYGB.