INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY

Area of Science:

• Gastroenterology
• Surgical Innovation
• Congenital Anomalies

Background:

• Intestinal malrotation is a rare congenital anomaly.
• It often presents asymptomatically in adults, leading to incidental diagnosis during surgery.
• Delayed diagnosis can complicate surgical planning and execution.

Purpose of the Study:

• To investigate the incidence and recognition of incidental intestinal malrotation during bariatric surgery.
• To evaluate the impact of malrotation on surgical technique and patient outcomes.
• To highlight the importance of pre-operative anatomical assessment.

Main Methods:

• Retrospective review of 20,000 bariatric surgery cases (2002-2016).
• Identification of patients with intestinal malrotation.
• Analysis of intraoperative findings, surgical modifications, and immediate post-operative evolution.

Main Results:

• Five cases (0.025%) of intestinal malrotation were identified in male patients with morbid obesity.
• Laparoscopic bariatric procedures were completed successfully with modifications.
• One sleeve gastrectomy and one single anastomosis gastric bypass were performed due to anatomical challenges.

Conclusions:

• Laparoscopic bariatric surgery is feasible in patients with intestinal malrotation.
• Surgical strategies may require adaptation based on the specific malrotation encountered.
• Thorough pre-operative abdominal anatomical assessment is crucial for safe surgical planning.