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Malrotation of the midgut in laparoscopic Roux-en-Y gastric bypass
Dilip Dan1, Nigel Bascombe, Dave Harnanan
1Department of Clinical Surgical Sciences, St. Augustine San Fernando General Hospital, The University of the West Indies, Trinidad, West Indies. dilipdan5@gmail.com
Objective:
To investigate the strategy of malrotation of the midgut encountered during laparoscopic gastrointestinal surgery.
Methods:
A 37 year old morbidly obese male (body weight=140 kg, BMI>65), presented with complaints of severe lower back pain and significant sleep apnea. After thorough pre-operative assessment, the patient was scheduled for a LRYGB procedure. Malrotation of midgut was found accidentally during the procedure. Besides scheduled LRYGB procedure, an incidental laparoscopic appendectomy was performed and Ladd bands were left intact.
Results:
The procedure was performed successfully. The total operative time was 3 hours and 10 minutes and the estimated blood loss was minimal. The patient had an uneventful post-operative recovery, an acceptable body weight loss and no longer complains of back pains or sleep apnea.
Conclusion:
Laparoscopic surgeons need to be mindful of the possibility of such anomalies during gastrointestinal surgery. LRYGB can be safely performed in patients with intestinal rotation disorders. Routine appendectomy should be considered as a useful addition to LRYGB in these patients.
