Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients: is a simple algorithm the answer?

Emmanuel A. Agaba, Charmaine V. Gentles, Hazem Shamseddeen, Venketesh Sasthakonar, Anuj Kandel, Dominick Gadelata, Larry Gellman

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Patients who have undergone laparoscopic gastric bypass have a high risk of developing an internal hernia. Most patients present 9-18 months postoperatively with a weight loss of 75-120 lb and pain out of proportion to the physical findings. Given the risks of internal hernias and the difficulty in radiologic diagnosis, we have developed a single algorithm to avoid the triage complication of a "missed" diagnosis. Methods: A retrospective review was performed of 1500 bariatric procedures performed from 2001 to 2006, 33% (laparoscopic Roux-en-Y gastric bypass) of which were performed using an antecolic antegastric Roux limb, with all potential defects, including Peterson's, closed. Of these 1500 patients, 75 were evaluated for abdominal pain to rule out an internal hernia. Results: Of the 75 patients, 40 had signs of an internal hernia or abdominal obstruction on computed tomography and underwent laparoscopy. The operative time was 38-45 minutes, and the length of stay was 1.5 days. The remaining 35 patient's computed tomography scans were interpreted as "no evidence" of internal hernia or obstruction. Of the 35 patients, 29 underwent diagnostic laparoscopy and had either an internal hernia or critical adhesions. Thus, 69 patients (92%) underwent diagnostic laparoscopy. In 6 patients, the symptoms resolved completely without any surgical intervention. Conclusion: At our institution, patients who undergo laparoscopic Roux-en-Y gastric bypass with a weight loss of 75-120 lb undergo computed tomography with contrast to rule out other potential nonoperative causes. Also, unless clinically stable or the patient has complete resolution of their pain, they then undergo laparoscopy for evaluation.

Original languageEnglish (US)
Pages (from-to)587-593
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume4
Issue number5
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

Fingerprint

Gastric Bypass
Abdominal Pain
Hernia
Laparoscopy
Tomography
Weight Loss
Abdominal Hernia
Bariatrics
Pain
Triage
Operative Time
Length of Stay
Extremities

Keywords

  • Algorithm
  • Gastric bypass
  • Internal hernia
  • Morbid surgery
  • Obesity surgery
  • Small bowel obstruction

ASJC Scopus subject areas

  • Surgery

Cite this

Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients : is a simple algorithm the answer? / Agaba, Emmanuel A.; Gentles, Charmaine V.; Shamseddeen, Hazem; Sasthakonar, Venketesh; Kandel, Anuj; Gadelata, Dominick; Gellman, Larry.

In: Surgery for Obesity and Related Diseases, Vol. 4, No. 5, 01.09.2008, p. 587-593.

Research output: Contribution to journalArticle

Agaba, Emmanuel A. ; Gentles, Charmaine V. ; Shamseddeen, Hazem ; Sasthakonar, Venketesh ; Kandel, Anuj ; Gadelata, Dominick ; Gellman, Larry. / Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients : is a simple algorithm the answer?. In: Surgery for Obesity and Related Diseases. 2008 ; Vol. 4, No. 5. pp. 587-593.
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AU - Sasthakonar, Venketesh

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AU - Gadelata, Dominick

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AB - Background: Patients who have undergone laparoscopic gastric bypass have a high risk of developing an internal hernia. Most patients present 9-18 months postoperatively with a weight loss of 75-120 lb and pain out of proportion to the physical findings. Given the risks of internal hernias and the difficulty in radiologic diagnosis, we have developed a single algorithm to avoid the triage complication of a "missed" diagnosis. Methods: A retrospective review was performed of 1500 bariatric procedures performed from 2001 to 2006, 33% (laparoscopic Roux-en-Y gastric bypass) of which were performed using an antecolic antegastric Roux limb, with all potential defects, including Peterson's, closed. Of these 1500 patients, 75 were evaluated for abdominal pain to rule out an internal hernia. Results: Of the 75 patients, 40 had signs of an internal hernia or abdominal obstruction on computed tomography and underwent laparoscopy. The operative time was 38-45 minutes, and the length of stay was 1.5 days. The remaining 35 patient's computed tomography scans were interpreted as "no evidence" of internal hernia or obstruction. Of the 35 patients, 29 underwent diagnostic laparoscopy and had either an internal hernia or critical adhesions. Thus, 69 patients (92%) underwent diagnostic laparoscopy. In 6 patients, the symptoms resolved completely without any surgical intervention. Conclusion: At our institution, patients who undergo laparoscopic Roux-en-Y gastric bypass with a weight loss of 75-120 lb undergo computed tomography with contrast to rule out other potential nonoperative causes. Also, unless clinically stable or the patient has complete resolution of their pain, they then undergo laparoscopy for evaluation.

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