"Candy cane" Roux syndrome--a possible complication after gastric bypass surgery.

BACKGROUND

An excessive length of nonfunctional Roux limb proximal to the gastrojejunostomy can cause abnormal upper gastrointestinal symptoms after gastric bypass surgery. The purpose of this study was to characterize the syndrome and provide the practitioner with diagnosis and management options.

METHODS

We performed a retrospective descriptive review of patients who had undergone revisional surgery for "candy cane" Roux syndrome.

RESULTS

From 2004 to 2006, 3 patients underwent revision because of a redundant proximal Roux limb. These 3 revisions were performed at 3, 12, and 36 months after the original Roux-en-Y gastric bypass procedure. The symptoms included regurgitation of food in 2 patients, reflux in 2, significant weight regain in 1, postprandial pain that was relieved after vomiting in 2, persistent nausea in 2, and epigastric fullness in 2 patients. The symptoms were progressive in all 3 patients. The resected length of bowel ranged from 8 to 15 cm. Three different surgeons had performed the initial gastric bypass, and a circular stapler had been used for the construction of the original gastrojejunostomy in all 3 patients. Resection of the excess Roux limb was performed laparoscopically in all cases, and all patients reported complete and immediate resolution of their symptoms.

CONCLUSION

A long, nonfunctional Roux limb tip may cause persistent nausea, postprandial epigastric pain, and, even, a lack of satiety. Surgeons should attempt to minimize redundancy in the Roux limb during the primary procedure. Additional studies may better characterize this possible complication.