Laparoscopy is preferred for small bowel obstruction in pregnancy after Roux-en-Y gastric bypass: a 10-year, single...

Pregnancy beyond the first trimester increases the risk of small bowel obstruction after Roux-en-Y gastric bypass, most often due to internal hernia. Surgical exploration can be challenging because of limited space and anatomical changes. Data on surgical and obstetrical outcomes are scarce.

We identified 32 pregnant women who underwent surgery for small bowel obstruction following bariatric surgery at our institution between January 2014 and December 2024. Data were collected on bariatric surgery history, operative details, postoperative complications, and obstetric outcomes.

All patients had a history of Roux-en-Y gastric bypass. Median gestational age at surgery was 23 weeks 0 days (IQR 17 + 3-29 + 6 weeks). The most common symptom was postprandial exacerbation of abdominal pain (74%, n = 29); vomiting occurred in 51% (n = 20). Intraoperative findings included chylous fluid (53%, n = 18) and venous small bowel congestion (26%, n = 9). Serosal tears occurred in 9% (n = 3), with one case requiring conversion to laparotomy. There were no ischemia-related bowel resections. No maternal or fetal deaths occurred. Median gestational age at delivery was 39 weeks 0 days (IQR 38 + 2-39 + 3 weeks), with a mean interval from surgery to delivery of 13 weeks 6 days (IQR 8 + 1-19 + 2 weeks).

Laparoscopy is a suitable therapeutic approach for pregnant patients with suspected small bowel obstruction following bariatric surgery. Surgical intervention during pregnancy did not negatively impact outcomes. Early recognition of atypical presentations by clinicians, together with patient education on warning signs, is essential to prevent diagnostic delays and improve outcomes.