Surgical management of candy cane syndrome after Roux-en-Y bypass

Area of Science:

• Bariatric Surgery
• Gastrointestinal Surgery
• Surgical Complications

Background:

• Candy cane (CC) syndrome is a complication following Roux-en-Y bypass (RYGB).
• It is characterized by a long, small-bowel blind limb at the gastrojejunostomy, potentially caused by circular staplers.
• This condition can lead to significant patient discomfort and complications.

Purpose of the Study:

• To report institutional experience with CC resection.
• To evaluate outcomes and symptom improvement following CC resection after RYGB.
• To identify strategies for preventing CC syndrome.

Main Methods:

• Retrospective analysis of patients undergoing CC resection from 2017-2023.
• Inclusion criteria: patients with a visualized afferent blind limb via upper GI study and endoscopy.
• Data collected included symptoms, operative details, and weight changes.

Main Results:

• Twenty-nine patients (83% female, mean age 50.3 years) underwent CC resection.
• Mean CC length was 7.5 cm; 58.6% had concomitant procedures.
• Significant symptom reduction (bloating, nausea, vomiting, dysphagia) observed at 8.5-month follow-up; BMI decreased from 32.1 to 29.1 kg/m².

Conclusions:

• Resection of the blind afferent limb is safe and effective.
• Excellent symptom resolution is achievable, even with concomitant procedures.
• Resecting excess Roux limb during initial RYGB may prevent CC syndrome.