In many centers, laparoscopic Roux-en-Y gastric bypass has become the most common bariatric procedure for morbid obesity.
In this operation, the stomach is stapled or divided to form a small pouch (typically <30 mL in volume), which empties into a Roux limb of the jejunum of varying length (typically 75-150 cm).
The Roux limb may be brought up to the gastric pouch in two ways:
- anterior to the transverse colon (antecolic-anterogastric)
- posterior to the transverse colon (retrocolic-retrogastric)
There are two anastomoses: a proximal gastrojejunal anastomosis and a distal jejunojejunal anastomosis.
Although any visible defects that might allow potential bowel herniation are routinely closed at surgery 2, the antecolic approach has become preferred at some centers because a retrocolic approach requires bringing the Roux limb through the mesenteries and markedly increases the rate of an internal hernia.
Early complications of gastrointestinal complications of gastric bypass surgery include 3:
- anastomotic leak: usually at the gastrojejunal anastomosis
- acute ischemia
- anastomotic narrowing/stenosis/stricture
- most common cause of postoperative nausea and vomiting
- may require lateral or steep oblique views to visualize
- rare at jejunojejunal anastomosis (0.9%)
- bezoar formation in the gastric pouch
- hemorrhage / hematoma
- adhesions / small-bowel obstruction
- internal hernia 2
- 1. Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am. J. Surg. 2002;184 (6B): 9S-16S. Am. J. Surg. (link) - Pubmed citation
- 2. Lockhart ME, Tessler FN, Canon CL et-al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007;188 (3): 745-50. doi:10.2214/AJR.06.0541 - Pubmed citation
- 3. Blachar A, Federle MP, Pealer KM et-al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223 (3): 625-32. doi:10.1148/radiol.2233011323 - Pubmed citation