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Vilallonga R, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Gonzalez O, Ruiz de Gordejuela A, Ciudin A, Armengol M, Fort JM. Reversal to Normal Anatomy (With Sleeve Gastrectomy) for Severe Hypoglycemia. Surg Innov 2020; 28:536-543. [PMID: 33381999 DOI: 10.1177/1553350620984647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background. Laparoscopic Roux-en-Y gastric bypass (GBP) is an essential bariatric surgical procedure which is globally performed because of the associated effective weight loss and resolution of metabolic comorbidities, such as diabetes and dyslipidemia. Although some complications may occur, hypoglycemia is a rare complication, which can lead to lethal consequences. We aimed to describe the technical aspects and surgical results after reversal to normal anatomy (RNA). Methods. We conducted a retrospective data analysis including 16 patients who underwent laparoscopic RNA from 2011 to 2018. All data were archived in a prospective database. Previous bariatric surgery and postoperative outcomes were analyzed. Results. Sixteen patients underwent RNA, most of them after GBP, and 15 patients required sleeve gastrectomy. Among them, 80% were women; 5 patients presented with postoperative complications, such as colitis with intra-abdominal collection (n = 1), gastric leak (n = 2) treated with an endoprosthesis, mesenteric venous thrombosis (n = 1), and intra-abdominal bleeding (n = 1). Mean length of hospital stay was 5.93 (3-30). All patients recovered from their initial condition although 3 patients presented with mild hypoglycemia during follow-up. Seven patients regained weight (43.75%), and another 4 developed gastroesophageal reflux disease (25%). Conclusions. These laparoscopic RNA results are acceptable, indicating a clinical improvement in the hypoglycemic syndrome in all patients.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain.,54809Research Institute against Digestive Cancer, Strasbourg, France
| | - Renato Roriz-Silva
- Department of Medicine, Federal University of Rondônia -Unir, Brazil.,Division of General Surgery, Hospital de Base of Porto Velho, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Amador Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Andrea Ciudin
- Endocrinolgy and Nutrition Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, 65462Vall Dd'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
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Portomesenteric Venous Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: a Case Report and Review of the Literature. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shoar S, Saber AA, Rubenstein R, Safari S, Brethauer SA, Al-Thani H, Asarian AP, Aminian A. Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients. Surg Obes Relat Dis 2018; 14:47-59. [DOI: 10.1016/j.soard.2017.09.512] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 12/14/2022]
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Bag H, Karaisli S, Celik SC, Kar H, Tatar F. A Rare Complication of Bariatric Surgery: Retrograde Intussusception. Obes Surg 2017; 27:2996-2998. [PMID: 28815437 DOI: 10.1007/s11695-017-2878-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Halis Bag
- General Surgery Department, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serkan Karaisli
- General Surgery Department, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Salih Can Celik
- General Surgery Department, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Haldun Kar
- General Surgery Department, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatma Tatar
- General Surgery Department, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Zaveri H, Dallal RM, Cottam D, Surve A, Kartiko S, Bonnani F, Cottam A, Cottam S. Indications and Operative Outcomes of Gastric Bypass Reversal. Obes Surg 2017; 26:2285-90. [PMID: 26883929 DOI: 10.1007/s11695-016-2105-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is one of the best-known and most commonly performed bariatric procedures. However, this procedure carries infrequent but serious long-term complications, which may require revisional procedures. This study reports the indications and outcomes of gastric bypass reversal that have not been described well in the literature. METHODS A multicenter retrospective study of 50 patients who underwent reversal of RYGB conducted between 2006 and 2015 was reviewed to describe the usual indications and outcomes of gastric bypass reversal surgeries. RESULTS Of 50 patients, 7 (14 %) were males and 43 (86 %) were females. The mean age of the patient population was 40.4 ± 11.6 years (range 19-66). Reasons for reversal included anastomotic ulcers (n = 27), anastomotic complications (n = 9), malnutrition (n = 2), and functional disorder (n = 12). The mean BMI before the reversal was 29 ± 9.4 kg/m(2) (range 16-60). The mean time between the primary procedure and reversal was 60 ± 65.5 months (range 2-300). Fourteen of the reversals were done via laparotomy. Mean hospital stay was 8.4 ± 7.3 days (range 3-34 days). There was no peri-operative death 30 days after reversal. Following gastric bypass reversal, 92.6 % (n = 25) of the patient population had resolution from ulcers, 77.8 % (n = 7) of the patient population had resolution from anatomic complications, 100 % (n = 2) of the patient population had resolution from malnutrition, and 66.7 % (n = 8) of the patient population had resolution from functional disorders. CONCLUSIONS Gastric bypass reversal is a reasonable and safe treatment for complications arising from the GBP surgery. A laparoscopic approach is feasible in select patients.
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Affiliation(s)
- Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Ramsey M Dallal
- Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA, 19027, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Susan Kartiko
- Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA, 19027, USA
| | - Fernando Bonnani
- Abington Memorial Hospital, 225 Newtown Rd, 2nd Flr-Main Bldg, Warminster, PA, 18974, USA
| | - Austin Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Pernar LI, Kim JJ, Shikora SA. Gastric bypass reversal: a 7-year experience. Surg Obes Relat Dis 2016; 12:1492-1498. [DOI: 10.1016/j.soard.2016.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
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Affiliation(s)
- Amar N. Mukerji
- Department of Surgery Bronx Lebanon Hospital Center Bronx, New York
| | - Ajay Shah
- Department of Surgery Bronx Lebanon Hospital Center Bronx, New York
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Pucher PH, Lord AC, Sodergren MH, Ahmed AR, Darzi A, Purkayastha S. Reversal to normal anatomy after failed gastric bypass: systematic review of indications, techniques, and outcomes. Surg Obes Relat Dis 2016; 12:1351-1356. [DOI: 10.1016/j.soard.2016.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/03/2016] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
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Carter CO, Fernandez AZ, McNatt SS, Powell MS. Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass. Surg Obes Relat Dis 2016; 12:572-576. [DOI: 10.1016/j.soard.2015.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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Roux-en-Y gastric bypass reversal: a systematic review. Surg Obes Relat Dis 2016; 12:1366-1372. [PMID: 27260651 DOI: 10.1016/j.soard.2016.02.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Due to the large number of Roux-en-Y gastric bypass surgeries performed over the last decade, reversal of the bypass to normal anatomy has been increasingly reported. SETTING University affiliated Teaching Hospital, United States. OBJECTIVES The aim of this systematic review was to summarize the literature data regarding the indications, technical considerations, and outcomes of gastric bypass reversal. METHODS PubMed/MEDLINE search was conducted for articles reporting reversal of gastric bypass to normal anatomy. Patients' demographic characteristics, primary reason for reversal, reversal technique, and postreversal events were retrieved and categorized from each eligible paper. RESULTS Thirty-five articles encompassing a total of 100 patients were eligible. Malnutrition was the most common indication for reversal (12.3%), followed by severe dumping syndrome (9.4%), postprandial hypoglycemia (8.5%), and excessive weight loss (8.5%). Techniques for gastrogastrostomy were available in 42 patients, with the hand-sewn technique as the most common (67.4%) followed by the linear stapler (23.2%) and the end-to-end anastomosis stapler used in 3 patients (6.9%). The reversal technique was performed endoscopically and described in 3 studies (3 patients). Techniques for handling the Roux limb were described in 56 patients (56%); the limb was reconnected in 32 patients (57.2%) and resected in 24 patients (42.8%). Weight regain was the most prevalent postreversal event (28.8%), followed by severe gastroesophageal reflux diseases (10.2%) and persistent abdominal pain (6.8%). There was no reported mortality. CONCLUSION Gastric bypass reversal is indicated for excessive weight loss, dumping syndrome, and postprandial hypoglycemia. The procedure is well tolerated and feasible when performed laparoscopically and has no reported mortality.
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Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results. Obes Surg 2016; 26:2014-2021. [DOI: 10.1007/s11695-016-2066-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Carilli S, Arısoy M, Alper A. A rare complication following laparoscopic Roux & Y gastric bypass: intussusception-case report. SPRINGERPLUS 2015; 4:603. [PMID: 26543738 PMCID: PMC4628016 DOI: 10.1186/s40064-015-1377-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Abstract
Obesity is a growing health problem in most parts of the world. Currently only proven long term effective treatment of obesity is bariatric surgery. Roux & Y gastric bypass together with sleeve gastrectomy are the most employed surgical techniques with acceptable metabolic and surgical complication rates. In this paper we would like to present an unexpected complication of Roux & Y gastric bypass: a retrograde intussusception located in the common limb 17 months after the surgery. As intussusception in adults usually originates from a leading point, there is no such an explanation following Roux & Y gastric bypass.
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Affiliation(s)
- Senol Carilli
- General Surgery Department, American Hospital, Guzelbahce Sokak No 20, Nisantasi, 34365 Istanbul, Turkey
| | - Mustafa Arısoy
- General Surgery Department, American Hospital, Guzelbahce Sokak No 20, Nisantasi, 34365 Istanbul, Turkey
| | - Aydin Alper
- General Surgery Department, American Hospital, Guzelbahce Sokak No 20, Nisantasi, 34365 Istanbul, Turkey
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Indications and outcomes of reversal of Roux-en-Y gastric bypass. Surg Obes Relat Dis 2015; 11:821-6. [DOI: 10.1016/j.soard.2014.11.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/12/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022]
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Management of anastomotic ulcers after Roux-en-Y gastric bypass: results of an international survey. Obes Surg 2015; 24:741-6. [PMID: 24347350 DOI: 10.1007/s11695-013-1152-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anastomotic ulcers (AUs) after Roux-en-Y gastric bypass (RYGB) occur in up to 16% of patients. In an international survey among members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), current preventative and therapeutic strategies in AU were analyzed. METHODS An Internet-based survey was performed. RESULTS One hundred eighty-nine surgeons completed the survey. Preoperative screening for Helicobacter pylori is performed by 65%. Eighty-eight percent of them prophylactically prescribe antacids for 3 months after surgery (interquartile range (IQR) 1-6). In case of AU, 99% of participants opt for proton pump inhibitors (PPIs) either alone (60%) or in combination with sucralfate (39%). After ulcer resolution, 52% continue PPI for 6 (3-6) months. In case of AU recurrence, 56% continue with conservative treatment. In contrast, 41% of them favor a renewal of the gastrojejunal anastomosis either combined with truncal vagotomy (18%) or with gastric remnant resection (13%), and only 2% choose to resect both gastric pouch and gastric remnant with subsequent reconstruction by esophagojejunostomy. In case of recurrence after surgical revision, 46% of participants opt again for a conservative approach, while 36% chose to redo the gastrojejunostomy once again. CONCLUSIONS The majority of bariatric surgeons recommend preoperative screening and eradication of H. pylori as well as prophylactic use of PPI. If an AU is diagnosed, the role of PPI as a first-line treatment seems to be undisputed. However, dosage and duration of therapy remain unclear. In refractory AU, there is no consensus among bariatric surgeons whether conservative treatment or surgical revision should be performed.
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Laparoscopic conversion of Roux-en-Y gastric bypass to sleeve gastrectomy for intractable marginal ulcer. Surg Obes Relat Dis 2015; 11:262-4. [DOI: 10.1016/j.soard.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 12/22/2022]
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Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 2014; 10:952-72. [PMID: 24776071 DOI: 10.1016/j.soard.2014.02.014] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reoperative bariatric surgery has become a common practice in many bariatric surgery programs. There is currently little evidence-based guidance regarding specific indications and outcomes for reoperative bariatric surgery. A task force was convened to review the current evidence regarding reoperative bariatric surgery. The aim of the review was to identify procedure-specific indications and outcomes for reoperative procedures. METHODS Literature search was conducted to identify studies reporting indications for and outcomes after reoperative bariatric surgery. Specifically, operations to treat complications, failed weight loss, and weight regain were evaluated. Abstract and manuscript reviews were completed by the task force members to identify, grade, and categorize relevant studies. RESULTS A total of 819 articles were identified in the initial search. After review for inclusion criteria and data quality, 175 articles were included in the systematic review and analysis. The majority of published studies are single center retrospective reviews. The evidence supporting reoperative surgery for acute and chronic complications is described. The evidence regarding reoperative surgery for failed weight loss and weight regain generally demonstrates improved weight loss and co-morbidity reduction after reintervention. Procedure-specific outcomes are described. Complication rates are generally reported to be higher after reoperative surgery compared to primary surgery. CONCLUSION The indications and outcomes for reoperative bariatric surgery are procedure-specific but the current evidence does support additional treatment for persistent obesity, co-morbid disease, and complications.
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Intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2014; 10:666-70. [PMID: 24935180 DOI: 10.1016/j.soard.2014.01.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/21/2013] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Jejuno-jejunal (J-J) intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB). Prompt diagnosis is critical as it may lead to obstruction and bowel necrosis, but clinical presentation is nonspecific. A definitive treatment plan has not been established with intussusception after RYGB. The aim of our study was to describe clinical presentation and outcomes of treatment in patients with intussusception after RYGB. METHODS Out of 3022 patients who underwent laparoscopic RYGB between January 2003 and January 2013, 12 (0.4%) patients presented with intussusception after RYGB. A retrospective review of a prospectively collected database was performed. RESULTS Of the 12 patients, 11 (91.7%) presented with left or right upper quadrant abdominal pain as their chief complaint, and 1 (8.3%) presented with persistent nausea and vomiting. Diagnosis was made by computed tomographic scan (n = 1) or intraoperative findings (n = 11) at a mean period of 24.9 ± 26.0 months (range 3-85) after laparoscopic RYGB. Seven (58.3%) patients were treated only with reduction, 2 (16.7%) with resection and revision of J-J anastomosis, the remaining 3 (25.0%) underwent imbrication/plication of the J-J anastomosis. Only 1 (8.3%) patient, who was treated by reduction, returned with subsequent finding of recurrent intussusception at 9 months. All patients did well at a mean follow-up of 12.7 ± 16.4 months (range 1-47). CONCLUSION While reduction alone of the intussusception is safe and effective, there is a risk of recurrence, and imbrication of the J-J anastomosis may be a more effective means of treatment.
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Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution. Surg Endosc 2014; 28:1624-8. [DOI: 10.1007/s00464-013-3361-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/20/2013] [Indexed: 01/06/2023]
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Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc 2013; 27:4640-8. [DOI: 10.1007/s00464-013-3087-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/24/2013] [Indexed: 01/20/2023]
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Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg 2011; 21:253-63. [PMID: 20949329 DOI: 10.1007/s11695-010-0298-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Small bowel intussusception is a rare long-term complication after Roux-en-Y gastric bypass, the etiology of which remains unclear. Except for one series reporting on 23 patients, case reports represent the vast majority of all cases reported so far. With this complete review of the world literature, based on a total of 63 patients including 2 of our own cases, we provide an extensive overview of the subject. The origin of intussusception after gastric bypass is different from that of intussusception of other causes, in that there is usually no lead point. It is likely related to motility disorders in the divided small bowel, especially in the Roux limb. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly. Clinical presentation is not specific. Computerized tomography scan represents the diagnostic test of choice, but surgery is sometimes the only way to establish the diagnosis. Treatment may be limited to reduction if the small bowel is viable, but resection of the affected segment is recommended on the basis of this review, since it seems to result in fewer recurrences. Knowledge of this entity and a high index of suspicion are required to make the correct diagnosis and offer appropriate treatment in a timely fashion.
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Affiliation(s)
- Loic Daellenbach
- Faculty of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
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