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Laparoscopic resection of intussusception after Roux-en-Y gastric bypass: comparison between the conventional and a simplified approach

      Intussusception after Roux-en-Y gastric bypass (RYGB) is a rare, long-term complication most commonly occurring in a retrograde fashion just distal to the jejunojejunostomy with approximately .5% incidence [
      • Elms L.
      • Moon R.C.
      • Varnadore S.
      • Teixeira A.F.
      • Jawad M.A.
      Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution.
      ]. Management options include reduction, pexy, and resection of jejunojejunostomy [
      • Varban O.
      • Ardestani A.
      • Azagury D.
      • et al.
      Resection or reduction? The dilemma of managing retrograde intussusception after Roux-en-Y gastric bypass.
      ,
      • Simper S.C.
      • Erzinger J.M.
      • McKinlay R.D.
      • Smith S.C.
      Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group's experience of 23 cases.
      ,
      • Stephenson D.
      • Moon R.C.
      • Teixeira A.F.
      • Jawad M.A.
      Intussusception after Roux-en-Y gastric bypass.
      ]. Our traditional approach in management of symptomatic intussusception is resection and creation of new jejunojejunostomy,y preferably end-to-side anastomosis with a smaller anastomosis of <60 mm. In this video, we compare 2 techniques used to resect the anastomosis. The first is the traditional way in which all limbs are resected and 2 new anastomoses are created. The second way is a simplified technique that involves transecting the biliopancreatic (BP) limb from the anastomosis, maintaining the Roux limb intact, and performing only 1 anastomosis to restore the anatomy. In this setting, patients had symptomatic intussusception with presenting symptoms of abdominal pain without obstructive symptoms.

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      References

        • Elms L.
        • Moon R.C.
        • Varnadore S.
        • Teixeira A.F.
        • Jawad M.A.
        Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution.
        Surg Endosc. 2014; 28: 1624-1628
        • Varban O.
        • Ardestani A.
        • Azagury D.
        • et al.
        Resection or reduction? The dilemma of managing retrograde intussusception after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2013; 9: 725-730
        • Simper S.C.
        • Erzinger J.M.
        • McKinlay R.D.
        • Smith S.C.
        Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group's experience of 23 cases.
        Surg Obes Relat Dis. 2008; 4: 77-83
        • Stephenson D.
        • Moon R.C.
        • Teixeira A.F.
        • Jawad M.A.
        Intussusception after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2014; 10: 666-670