Surgical endoscopy · 2026
Hemobezoar-related jejunojejunostomy obstruction after minimally invasive Roux-en-Y gastric bypass: a systematic review.
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Theis Claudia, Nunes Victor Andrade, Rice Sarah Grace, Scott S Davis, Farrell Timothy M, Hodges Maggie, Fernandez Samuel Ricardo Torres Landa
Аннотация
BACKGROUND: Hemobezoar-related jejunojejunostomy (JJ) obstruction is a rare early complication after minimally invasive Roux-en-Y gastric bypass (RYGB). Although early small bowel obstruction after RYGB is well described, obstruction caused by hemobezoar formation remains poorly characterized.
METHODS: This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261320591). PubMed/MEDLINE, Embase, and CENTRAL were searched from inception through February 2026. Eligible studies reported adults undergoing primary minimally invasive RYGB with early hemobezoar-related JJ obstruction. Data were extracted on study characteristics, presentation, diagnostic modality, operative strategy, gastric decompression, and outcomes. Given its rarity and lack of comparative cohorts, findings were summarized descriptively.
RESULTS: Six studies met inclusion criteria, including 7669 minimally invasive RYGB procedures and 29 hemobezoar-related JJ obstructions. The crude incidence was 0.38%, with per-study incidence ranging from 0.09% to 1.94%. Presentation was consistently early, most commonly within 72 postoperative hours, frequently included tachycardia, nausea, vomiting, abdominal pain, hematocrit decline, and gastrointestinal bleeding. Computed tomography with intravenous contrast was the predominant diagnostic modality, demonstrating dilation of the excluded stomach and proximal limbs with hyperdense intraluminal content at the JJ. Operative management evolved from laparotomy with JJ revision in earlier reports to laparoscopic clot evacuation with selective revision when anastomotic compromise, leak, ischemia, or ongoing bleeding was identified. Gastric remnant decompression was emphasized to reduce closed-loop distension and intraperitoneal contamination. No deaths were reported among 29 cases, although morbidity included abscess formation, anastomotic or staple-line complications, pancreatitis, respiratory complications, readmission, and repeat reoperation.
CONCLUSION: Hemobezoar-related JJ obstruction after minimally invasive RYGB is uncommon but important. It typically presents within the first postoperative days with obstructive symptoms and evidence of intraluminal bleeding. Across retrospective studies, favorable outcomes were reported following prompt CT diagnosis, early operative exploration, remnant decompression, and minimally invasive clot evacuation with selective anastomotic revision. Prospective validation of this management approach is needed.
METHODS: This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261320591). PubMed/MEDLINE, Embase, and CENTRAL were searched from inception through February 2026. Eligible studies reported adults undergoing primary minimally invasive RYGB with early hemobezoar-related JJ obstruction. Data were extracted on study characteristics, presentation, diagnostic modality, operative strategy, gastric decompression, and outcomes. Given its rarity and lack of comparative cohorts, findings were summarized descriptively.
RESULTS: Six studies met inclusion criteria, including 7669 minimally invasive RYGB procedures and 29 hemobezoar-related JJ obstructions. The crude incidence was 0.38%, with per-study incidence ranging from 0.09% to 1.94%. Presentation was consistently early, most commonly within 72 postoperative hours, frequently included tachycardia, nausea, vomiting, abdominal pain, hematocrit decline, and gastrointestinal bleeding. Computed tomography with intravenous contrast was the predominant diagnostic modality, demonstrating dilation of the excluded stomach and proximal limbs with hyperdense intraluminal content at the JJ. Operative management evolved from laparotomy with JJ revision in earlier reports to laparoscopic clot evacuation with selective revision when anastomotic compromise, leak, ischemia, or ongoing bleeding was identified. Gastric remnant decompression was emphasized to reduce closed-loop distension and intraperitoneal contamination. No deaths were reported among 29 cases, although morbidity included abscess formation, anastomotic or staple-line complications, pancreatitis, respiratory complications, readmission, and repeat reoperation.
CONCLUSION: Hemobezoar-related JJ obstruction after minimally invasive RYGB is uncommon but important. It typically presents within the first postoperative days with obstructive symptoms and evidence of intraluminal bleeding. Across retrospective studies, favorable outcomes were reported following prompt CT diagnosis, early operative exploration, remnant decompression, and minimally invasive clot evacuation with selective anastomotic revision. Prospective validation of this management approach is needed.