Late Jejunojejunal Perforation After Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Narrative Review

Area of Science:

• Bariatric Surgery
• Gastrointestinal Surgery
• Surgical Complications

Background:

• Late jejunojejunal (JJ) anastomosis perforation is a rare but life-threatening complication following laparoscopic Roux-en-Y gastric bypass (LRYGB).
• Non-specific presentations and varied causes can delay diagnosis and increase patient morbidity.

Purpose of the Study:

• To systematically review and synthesize published literature on late JJ perforation after LRYGB.
• To analyze patient characteristics, clinical presentation, timing, causes, and outcomes of this complication.

Main Methods:

• Comprehensive literature search of PubMed, CINAHL Plus, Embase, and EBSCOhost up to October 2025.
• Inclusion of case reports and series describing late JJ perforation in adults post-LRYGB.
• Systematic review and narrative synthesis of extracted data; meta-analysis was not feasible.

Main Results:

• Twelve cases from eight studies were identified, predominantly middle-aged females presenting months to years post-LRYGB.
• Patients experienced severe, acute abdominal pain with variable radiological findings.
• Proposed causes included marginal ulcers, ischemia, infection, stress, phytobezoar, and tumor implantation.

Conclusions:

• Late JJ perforation, though rare after LRYGB, must be considered in acute abdomen presentations post-bariatric surgery.
• Early cross-sectional imaging, diagnostic laparoscopy, and prompt surgical intervention are vital for favorable outcomes.
• Standardized reporting and registries are needed to better define incidence, risk factors, and management strategies.