Abstract
Background: Early small bowel obstruction (ESBO; within 30 d of surgery) after laparoscopic gastric bypass (LRYGB) is reported in.5% to 5.2% of primary cases, but it is associated with significant morbidity, and the treatment is not standardized. Objectives: To review prevalence, causes, management, and outcomes of patients treated for ESBO after LRYGB. Setting: Tertiary academic medical center. Methods: Retrospective review to identify consecutive patients who underwent primary LRYGB and those who developed ESBO from January 2000 through June 2017. Data included demographic characteristics, co-morbidities, LRYGB technical details, and ESBO clinical presentation, location, causes, treatment, and outcomes. Results: One thousand seven hundred seventeen patients (84.2% females) had LRYGB. Mean age and body mass index was 42.4 ± 11.1 years and 48.2 ± 7.3 kg/m 2 , respectively. Twenty-nine patients (1.7%) had ESBO. All patients presented with symptoms, most commonly nausea and vomiting (n = 17), on average 4.1 ± 5.9 days postoperatively; most required reoperation (n = 23, 79.3%) and 5 required >1 reoperation. Location of the obstruction and treatment used were the following: (1) jejuno-jejunostomy (n = 17, 58.6%; narrowing or clot), treated with reoperation in 11; and (2) other than at the jejuno-jejunostomy (n = 12, 41.4%; trocar site, incisional or internal hernia, adhesions, mesenteric ischemia), treated with reoperation in all. All ESBO patients had additional complications, 6 (20.1%) developed an anastomotic leak, and 2 (6.9%) died. Conclusion: ESBO infrequently occurs after LRYGB; many causes are technique related and possibly preventable. However, it is associated with significant morbidity and mortality. A high index of clinical suspicion, rapid and appropriate imaging, and prompt operative intervention are recommended. © 2018 American Society for Bariatric Surgery