Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution.

BACKGROUND: Internal hernia is a relatively common postoperative complication after Roux-en-Y gastric bypass (RYGB) procedure. It has been reported that 1-9 % of laparoscopic RYGB patients develop internal herniation through Peterson's or mesenteric defect. However, a considerable number of patients presenting with possible small bowel obstruction (SBO) after laparoscopic RYGB do not always have internal herniation.

PURPOSE: The aim of our study was to determine the causes of SBO for patients in which both potential internal hernia spaces were closed at the time of the original operation.

SETTING: Academic Practice, USA.

MATERIALS AND METHODS: Of 2,395 patients who underwent laparoscopic RYGB between January 2004 and October 2012, a total of 93 (3.9 %) patients were reoperated for possible SBO at our institution. A retrospective review of a prospectively collected database was performed for all patients.

RESULTS: A total of 93 patients had 105 reoperations in the study period, resulting in a reoperation rate for possible SBO of 3.9 %. The mean time period between the laparoscopic RYGB and the first 93 reoperations was 20.9 ± 18.1 months (range 0-100). Eleven patients required secondary reoperations at a mean period of 20.1 ± 17.7 months (range 0-52) after the first reoperation. Of these 105 reoperations, 29 (27.6 %) showed internal herniation at the mesenteric defect (N = 23), Peterson's defect (N = 5), and both (N = 1). A total of 50 (47.6 %) reoperations revealed extensive adhesions causing SBO. Of these 50 cases, 12 revealed adhesions at the jejunojejunostomy, causing it to kink and obstruct. Ten (9.5 %) cases showed intussusception of the jejunojejunal anastomosis. Overall, reoperation rate due to internal herniation was 1.1 % in our patient population.

CONCLUSIONS: Our findings indicate a 3.9 % reoperation rate for abdominal pain and SBO, and more than 45 % of these patients had symptoms secondary to adhesions. Only 1.1 % of our laparoscopic RYGB patients developed internal herniation after closure of both internal hernia spaces.