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首页> 外文期刊>Surgical Endoscopy >Causes of small bowel obstruction after Roux-en-Y gastric bypass: A review of 2,395 cases at a single institution
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Causes of small bowel obstruction after Roux-en-Y gastric bypass: A review of 2,395 cases at a single institution

机译：Roux-en-Y胃搭桥术后小肠梗阻的原因：单个机构的2395例病例回顾

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Background: Internal hernia is a relatively common postoperative complication after Roux-en-Y gastric bypass (RYGB) procedure. It has been reported that 1-9 % of laparoscopic RYGB patients develop internal herniation through Peterson's or mesenteric defect. However, a considerable number of patients presenting with possible small bowel obstruction (SBO) after laparoscopic RYGB do not always have internal herniation. Purpose: The aim of our study was to determine the causes of SBO for patients in which both potential internal hernia spaces were closed at the time of the original operation. Setting: Academic Practice, USA. Materials and methods: Of 2,395 patients who underwent laparoscopic RYGB between January 2004 and October 2012, a total of 93 (3.9 %) patients were reoperated for possible SBO at our institution. A retrospective review of a prospectively collected database was performed for all patients. Results: A total of 93 patients had 105 reoperations in the study period, resulting in a reoperation rate for possible SBO of 3.9 %. The mean time period between the laparoscopic RYGB and the first 93 reoperations was 20.9 ± 18.1 months (range 0-100). Eleven patients required secondary reoperations at a mean period of 20.1 ± 17.7 months (range 0-52) after the first reoperation. Of these 105 reoperations, 29 (27.6 %) showed internal herniation at the mesenteric defect (N = 23), Peterson's defect (N = 5), and both (N = 1). A total of 50 (47.6 %) reoperations revealed extensive adhesions causing SBO. Of these 50 cases, 12 revealed adhesions at the jejunojejunostomy, causing it to kink and obstruct. Ten (9.5 %) cases showed intussusception of the jejunojejunal anastomosis. Overall, reoperation rate due to internal herniation was 1.1 % in our patient population. Conclusions: Our findings indicate a 3.9 % reoperation rate for abdominal pain and SBO, and more than 45 % of these patients had symptoms secondary to adhesions. Only 1.1 % of our laparoscopic RYGB patients developed internal herniation after closure of both internal hernia spaces.
机译：背景：内部疝气是Roux-en-Y胃搭桥术（RYGB）术后相对常见的术后并发症。据报道，有1-9％的腹腔镜RYGB患者通过彼得森氏病或肠系膜缺陷发展为内部疝。但是，相当多的患者在腹腔镜RYGB术后出现可能的小肠梗阻（SBO）并不总是具有内部疝。目的：我们的研究目的是确定最初手术时两个潜在的内部疝气空间均已关闭的患者发生SBO的原因。地点：美国学术实践。材料和方法：在2004年1月至2012年10月间接受腹腔镜RYGB手术的2395例患者中，共有93例（3.9％）患者在我们机构接受了可能的SBO再次手术。对所有患者进行前瞻性收集数据库的回顾性回顾。结果：在研究期间，共有93例患者进行了105次再手术，因此SBO的再手术率为3.9％。腹腔镜RYGB与前93次再次手术之间的平均时间间隔为20.9±18.1个月（范围为0-100）。 11例患者在第一次手术后平均需要20.1±17.7个月（0-52范围）进行二次手术。在这105例再手术中，有29例（27.6％）在肠系膜缺损处（N = 23），彼得森氏缺损（N = 5）和两者（N = 1）均显示出内部疝。总共进行了50次（47.6％）再次手术，发现广泛的粘连导致SBO。在这50例病例中，有12例在空肠空肠造口处发现粘连，导致其扭结和阻塞。十例（9.5％）显示肠套叠空肠吻合。总体而言，在我们的患者人群中，由于内部疝引起的再手术率为1.1％。结论：我们的发现表明，腹痛和SBO的再手术率为3.9％，其中超过45％的患者具有继发于粘连的症状。我们的腹腔镜RYGB患者中只有1.1％的患者在两个内部疝气腔均关闭后发展为内部疝。

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