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Laparoscopic reoperation for early complications of laparoscopic gastric bypass
Pavlos K Papasavas1, Michael S O'Mara, Robert F Quinlin
1Temple University School of Medicine, Clinical Campus, Western Pennsylvania Hospital, Pittsburgh, PA, USA.
Background:
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a popular operation for morbid obesity. Early complications can be treated successfully with a laparoscopic approach. We reviewed our experience with laparoscopic re-exploration in the early postoperative period.
Methods:
The initial 85 patients who underwent LRYGBP by two surgeons at a training hospital were reviewed. All patients who required re-exploration within the first 60 days postoperatively were considered.
Results:
Nine patients underwent ten laparoscopic explorations. Mean BMI was 50 kg/m2. One patient underwent revision for proximal anastomotic obstruction at 58 days postoperatively. Three patients developed obstruction at the level of the transverse mesocolon secondary to cicatrix and required laparoscopic release of the scar tissue. Two patients required revision of the jejuno-jejunostomy. Internal hernia through the mesenteric defect at the level of the transverse mesocolon was the cause of bowel obstruction in two patients. One patient underwent lysis of adhesions between the left colon and the transverse mesocolon at 6 days postoperatively. One out of the ten laparoscopic re-explorations was negative for any findings. Eight patients recovered without further complications and one patient required endoscopic dilatations of the proximal anastomosis.
Conclusion:
In the course of treating morbid obesity with laparoscopic intervention, complications will arise. Laparoscopic exploration for early complications is a safe and feasible option.