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  • Title: Small bowel obstruction after antecolic and antegastric laparoscopic Roux-en-Y gastric bypass: could the incidence be reduced?
    Author: Rodríguez A, Mosti M, Sierra M, Pérez-Johnson R, Flores S, Dominguez G, Sánchez H, Zarco A, Romay K, Herrera MF.
    Journal: Obes Surg; 2010 Oct; 20(10):1380-4. PubMed ID: 20401758.
    Abstract:
    BACKGROUND: Small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB) may be related to the surgical technique used. The frequency and characteristics of postoperative SBO were studied in two cohorts of patients after LRYGB. METHODS: In a 4-year period, 359 patients underwent LRYGB as an initial bariatric operation at our clinic. Patients were divided into two groups. In Group 1 (n = 187), the mesentery of the jejunum was widely divided, the mesenteric defect was closed, and Petersen's space was not sutured. In Group 2 (n = 172), the mesentery was not divided, and both the mesenteric folds and Petersen's space were closed. Episodes of SBO, etiology, treatment, and outcome were analyzed and compared. RESULTS: There were 141 males and 218 females, with mean age of 41 ± 11 years. Preoperative BMI was 43.2 ± 7 kg/m(2). In Group 1, 29/187 patients (15.5%) developed SBO at a mean follow-up of 15 ± 6.4 months. In Group 2, 2/172 patients (1.1%) developed SBO at 12.3 ± 6.7 months. Internal hernia was responsible for the SBO in 29 patients (19 through the adjacent mesenteric defect and 10 through Petersen's space). Mean EWL at the time of SBO was 82.2 ± 22.7%. SBO was successfully resolved by laparoscopy in 25 patients, conversion was necessary in three, and one was treated by open surgery. One patient presented intestinal perforation after revision. CONCLUSIONS: Surgical details such as leaving the jejunal mesentery intact and closing all created defects significantly decreased the incidence of SBO due to internal hernias in antecolic antegastric LRYGB.
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