Archives of surgery (Chicago, Ill. : 1960) · 2007
Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Husain Syed, Ahmed Ahmed R, Johnson Joseph, Boss Thad, O'Malley William
Аннотация
OBJECTIVE: To summarize our experience with small-bowel obstructions after laparoscopic Roux-en-Y gastric bypass.
DESIGN: Retrospective record review.
SETTING: University-affiliated hospital.
PATIENTS: One hundred five consecutive patients undergoing surgery for intestinal obstruction after laparoscopic Roux-en-Y gastric bypass between May 24, 2001, and December 1, 2006.
MAIN OUTCOME MEASURES: Common presenting symptoms, causes, yield of radiological studies, and types of surgical procedures performed for post-gastric bypass bowel obstruction.
RESULTS: A total of 2325 laparoscopic Roux-en-Y gastric bypass procedures were performed during the study period. A total of 105 patients underwent 111 procedures. Bowel obstruction was confirmed in 102 patients, yielding an overall incidence of 4.4%. The most common presenting symptom was abdominal pain (82.0%), followed by nausea (48.6%) and vomiting (46.8%). Thirty-one patients (27.9%) presented with all of the 3 mentioned symptoms. The mean time to presentation was 313 days after bypass (range, 3-1215 days). Among the studies, results in 48.0% of computed tomographic scans, 55.4% of upper gastrointestinal studies, and 34.8% of plain abdominal radiography studies were positive for intestinal obstruction. In 15 patients (13.5%), all of the radiological study results were negative. The most common causes were internal hernias (53.9%), Roux compression due to mesocolon scarring (20.5%), and adhesions (13.7%). Laparoscopic explorations were carried out in 92 cases (82.9%). The incidences of bowel obstructions were 4.8% with retrocolic Roux placement and 1.8% with antecolic Roux placement.
CONCLUSIONS: Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.
DESIGN: Retrospective record review.
SETTING: University-affiliated hospital.
PATIENTS: One hundred five consecutive patients undergoing surgery for intestinal obstruction after laparoscopic Roux-en-Y gastric bypass between May 24, 2001, and December 1, 2006.
MAIN OUTCOME MEASURES: Common presenting symptoms, causes, yield of radiological studies, and types of surgical procedures performed for post-gastric bypass bowel obstruction.
RESULTS: A total of 2325 laparoscopic Roux-en-Y gastric bypass procedures were performed during the study period. A total of 105 patients underwent 111 procedures. Bowel obstruction was confirmed in 102 patients, yielding an overall incidence of 4.4%. The most common presenting symptom was abdominal pain (82.0%), followed by nausea (48.6%) and vomiting (46.8%). Thirty-one patients (27.9%) presented with all of the 3 mentioned symptoms. The mean time to presentation was 313 days after bypass (range, 3-1215 days). Among the studies, results in 48.0% of computed tomographic scans, 55.4% of upper gastrointestinal studies, and 34.8% of plain abdominal radiography studies were positive for intestinal obstruction. In 15 patients (13.5%), all of the radiological study results were negative. The most common causes were internal hernias (53.9%), Roux compression due to mesocolon scarring (20.5%), and adhesions (13.7%). Laparoscopic explorations were carried out in 92 cases (82.9%). The incidences of bowel obstructions were 4.8% with retrocolic Roux placement and 1.8% with antecolic Roux placement.
CONCLUSIONS: Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.