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Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients: is a simple algorithm the answer?
Surg Obes Relat Dis. 2008 Sep-Oct; 4(5):587-93.SO

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.

Authors+Show Affiliations

Department of Surgery, North Shore University Hospital, Manhasset, New York 11030, USA. eagaba@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18226974

Citation

Agaba, Emmanuel A., et al. "Retrospective Analysis of Abdominal Pain in Postoperative Laparoscopic Roux-en-Y Gastric Bypass Patients: Is a Simple Algorithm the Answer?" Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 4, no. 5, 2008, pp. 587-93.
Agaba EA, Gentles CV, Shamseddeen H, et al. Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients: is a simple algorithm the answer? Surg Obes Relat Dis. 2008;4(5):587-93.
Agaba, E. A., Gentles, C. V., Shamseddeen, H., Sasthakonar, V., Kandel, A., Gadelata, D., & Gellman, L. (2008). Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients: is a simple algorithm the answer? Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 4(5), 587-93. https://doi.org/10.1016/j.soard.2007.10.015
Agaba EA, et al. Retrospective Analysis of Abdominal Pain in Postoperative Laparoscopic Roux-en-Y Gastric Bypass Patients: Is a Simple Algorithm the Answer. Surg Obes Relat Dis. 2008 Sep-Oct;4(5):587-93. PubMed PMID: 18226974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients: is a simple algorithm the answer? AU - Agaba,Emmanuel A, AU - Gentles,Charmaine V, AU - Shamseddeen,Hazem, AU - Sasthakonar,Venketesh, AU - Kandel,Anuj, AU - Gadelata,Dominick, AU - Gellman,Larry, Y1 - 2008/01/28/ PY - 2007/06/03/received PY - 2007/09/03/revised PY - 2007/10/19/accepted PY - 2008/1/30/pubmed PY - 2008/12/17/medline PY - 2008/1/30/entrez SP - 587 EP - 93 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 4 IS - 5 N2 - 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. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/18226974/Retrospective_analysis_of_abdominal_pain_in_postoperative_laparoscopic_Roux_en_Y_gastric_bypass_patients:_is_a_simple_algorithm_the_answer L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(07)00714-9 DB - PRIME DP - Unbound Medicine ER -