Intestinal malrotation discovered at the time of laparoscopic Roux-en-Y gastric bypass

Four morbidly obese women who met the NIH criteria for bariatric surgery had laparoscopic Roux-en-Y gastric bypass. At operation, each was found to have intestinal malrotation. Two cases were completed laparoscopically, and two were converted to open operation because of difficulty defining the anatomy. All four operations were successful with no immediate complications and patients tolerated the procedures well. We present the four cases and offer recommendations should this unusual congenital defect be discovered at the time of laparoscopic gastric bypass.