Gastrointestinal Complications of Laparoscopic Roux-en-Y Gastric Bypass Surgery

Gastrointestinal Complications of Laparoscopic Roux-en-Y Gastric Bypass Surgery: Clinical and Imaging Findings
Arye Blachar, MD ; Michael P. Federle, MD ; Karen M. Pealer, BS ; Sayeed Ikramuddin, MD ; Philip R. Schauer, MD

1 From the Department of Radiology (A.B., M.P.F., K.M.P.) and the Center for Minimally Invasive Surgery, Department of Surgery (S.I., P.R.S.), University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213. Received August 3, 2001; revision requested September 25; revision received October 15; accepted October 25.

PURPOSE: To report the complications and imaging findings in a large group of patients who underwent Roux-en-Y gastric bypass (GBP) surgery.

MATERIALS AND METHODS: Four hundred sixty-three patients were evaluated for upper gastrointestinal (GI) complications following Roux-en-Y GBP surgery. Major complications were those that required surgical or radiologic intervention and minor complications were those that resolved spontaneously. The time from surgery to complication and findings from upper GI series and computed tomography (CT) of the major complications and minor leaks were reviewed.

RESULTS: Forty-four patients had 56 major complications: 23 small-bowel obstructions (14 internal hernias and nine adhesions), 16 major leaks, 15 anastomotic strictures, and two fistulas. There were 13 minor leaks and 18 other complications. Internal hernias were late complications and had a variety of findings at upper GI series and CT. Leaks were early complications and usually originated from the gastrojejunal anastomosis; findings from upper GI series and CT demonstrated extraluminal gas, contrast material, or both. Anastomotic strictures were late complications and were diagnosed at upper GI series with rounded dilation of the pouch and delayed emptying.

CONCLUSION: Upper GI complications that required intervention occurred in 9.5% of patients. CT and upper GI series can depict most major complications.