Afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction

The incidence of afferent loop obstruction after gastrectomy with Roux-en-Y reconstruction has not yet been reported. The aim of this study was to elucidate the incidence of afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction performed through an open approach.

We conducted a retrospective review of the data of 1908 patients who underwent distal gastrectomy followed by Roux-en-Y reconstruction through an open approach between January 1999 and December 2008.

Four patients (0.2%) developed afferent loop obstruction. The median age of the patients, consisting of three men and one woman, was 64 years (range 46-78 years). The cause of the afferent loop obstruction was internal herniation in two patients, adhesion in one patient, and peritoneal recurrence in one patient. The internal herniation occurred at the mesenteric gap in the region of the jejunojejunostomy. The interval between the initial gastrectomies and the emergency operations for afferent loop obstruction ranged from 3 weeks to 2 years (median 5 months). Three of the four patients were symptomatic, with vomiting and abdominal pain. All patients recovered following the emergency operations, and none died of this complication.

Afferent loop obstruction develops rarely after distal gastrectomy with Roux-en-Y reconstruction through an open approach. This rare but fatal complication should be considered when a patient complains of abdominal pain and/or vomiting after distal gastrectomy with Roux-en-Y reconstruction.