Laparoscopic treatment for intestinal occlusion following gastric bypass

Bowel obstruction after laparoscopic gastric bypass has been frequently reported. All bariatric surgeons, general surgeons, and physicians involved with postoperative management of the bariatric surgery patient should be familiar with this potentially life-threatening complication because an early diagnosis can prevent major complications. This video shows the laparoscopic treatment of bowel occlusion after gastric bypass.

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Laparoscopic treatment for intestinal occlusion following gastric bypass

Authors

F Costantino, J Marescaux

Abstract

Bowel obstruction after laparoscopic gastric bypass has been frequently reported. All bariatric surgeons, general surgeons, and physicians involved with postoperative management of the bariatric surgery patient should be familiar with this potentially life-threatening complication because an early diagnosis can prevent major complications. This video shows the laparoscopic treatment of bowel occlusion after gastric bypass.

Keywords

Laparoscopic treatment, intestinal occlusion, gastric bypass, Roux-en-Y

Media type

Surgical video

Duration

09'00''

Publication

2011-02

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E-publication

WeBSurg.com, Feb 2011;11(02).
URL: http://www.websurg.com/doi-vd01en3205.htm

Laparoscopic treatment for intestinal occlusion following gastric bypass

1. Introduction 00'22''

The objective of this film is to demonstrate a standard exploration following a gastric bypass. The exploration is carried out to manage abdominal pain.

2. Alimentary loop exploration 00'35''

First, the alimentary loop is explored at the level of the gastrojejunal anastomosis. In this case, the stomach, which had been dissected in the previous intervention, is excluded.

3. Petersen’ space control 00'52''

The procedure is continued caudally towards Petersen’s space, which is completely closed. A routine exploration is carried out. Adhesions can be found between the anastomosis of the foot of the loop and the alimentary loop, which can be seen quite frequently. It shows no clinical evidence.

4. Inferior anastomosis exploration 01'25''

The anastomosis of the foot of the loop is then explored.

5. Biliary loop exploration 01'37''

The biliary loop is explored until its insertion at the level of Treitz’s angle. This loop shows no clinical or pathological evidence. The procedure is then continued at the level of the anastomosis of the foot of the loop. Both the common and the biliary loop can be seen.

6. Second case 02'02''

This is the case of a 28-year-old female patient presenting with an intestinal occlusion. She benefited from a gastric bypass in 2009, when her BMI was 50. She lost 70% of her excess weight. She presented with abdominal pain, distension, complete arrest of the passage of contents and gas through the small bowel, and vomiting. Abdominal distension was confirmed by the clinical examination. CT-scan images demonstrate the presence of an intestinal occlusion due to bands. The strategy used is similar to the one just observed before.

7. Identification of a band on the alimentary loop 02'42''

The exploration demonstrates the presence of a band at the level of the alimentary loop and the mesenteric root.

8. Alimentary loop exploration 02'50''

Exploration is carried on at the level of the alimentary loop with the presence of distension. This distension is comparable to the one described in the previous case. The exploration is carried on all along the alimentary loop. The same adhesions as in the previous case can be found between the anastomosis of the foot of the loop and the alimentary loop.

9. Anastomosis exploration 03'21''

The exploration is then carried out at the level of the anastomosis of the foot of the loop. It is necessary to find one’s landmarks, namely the duodenal loop and the common loop. Both loops can be seen here.

10. Duodenal loop exploration 03'41''

Exploration of the duodenal loop is then performed. It is not dilated. The common loop is then explored. This kind of exploration is carried out systematically, despite the fact that the cause of the intestinal occlusion had been identified and managed since the beginning of the surgery.

11. Exploration of Petersen\'s space 04'28''

Exploration is carried on to rule out the presence of defects at the level of the spaces, here Petersen’s space, which can be seen here. It is completely closed. The mesenteric defect is also closed. Exploration is carried on over the alimentary loop. It demonstrates that the small bowel has a normal position after a Roux-en-Y gastric bypass.