Abstract
Introduction
Jejunojejunal intussusception after Roux-en-Y gastric bypass (RYGBP) for morbid obesity is a rare but potentially catastrophic complication. There are limited data regarding the incidence of intussusception and the different surgical options for management of this disease.
Methods
This is a retrospective review of all patients that underwent RYGBP and subsequently developed intussusception at the jejunojejunostomy. Data were collected between 1/1/2008 and 5/31/2018 and included demographics, details related to the index procedure, presentation, and management of intussusception. Perioperative outcomes and complications were also collected.
Results
665 patients underwent RYGBP. A total of 34 patients developed intussusception, with 31 (4.7%) of them having undergone RYGBP in our hospital. Demographics included age, gender, and BMI at both the index surgery and at the time of intussusception. The jejunojejunostomy was created during RYGBP using a linear stapler in all patients with 64.5% of them achieving a length of 90 mm. All intussuscepted patients presented acutely with abdominal pain. All but one patient required surgical intervention. 42.4% of the patients were found to have intraoperative intussusception which appeared to be retrograde in 78.6% of them. Reduction followed by enteropexy or just enteropexy was performed in 20 patients (60.6%) that required surgery. No immediate post-operative complications were noted but 8 patients (26.5%) had recurrence of intussusception requiring another surgical intervention. In the reoperated group, 75% of the patients were treated with reduction followed by enteropexy or just enteropexy.
Conclusions
This is the largest case series describing jejunojejunal intussusception following RYGBP. All patients that developed intussusception had jejunojejunostomy length greater than 60 mm. The most commonly performed surgical repair was reduction of the intussuscepted segment (if present) followed by enteropexy. Jejunojejunostomy length greater than 60 mm might be associated with the occurrence of intussusception and could explain the higher incidence noted in our series. Minimal intervention with enteropexy can offer effective treatment for most patients.
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Acknowledgements
We would like to thank Marina K Dimitriadis for the drawings of antegrade and retrograde intussusception.
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Dr. Romanelli is a consultant for Medtronic. This consultation was not related to the topic of this manuscript.Drs. Georgios Orthopoulos, Heather Grant, Parth Sharma, Erin Thompson, and John R. Romanelli have no conflicts of interest or financial ties to disclose.
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Orthopoulos, G., Grant, H.M., Sharma, P. et al. S054: incidence and management of jejunojejunal intussusception after Roux-en-Y gastric bypass: a large case series. Surg Endosc 34, 2204–2210 (2020). https://doi.org/10.1007/s00464-019-07009-0
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DOI: https://doi.org/10.1007/s00464-019-07009-0