Lewis Catherine E, Jensen Candice, Tejirian Talar, Dutson Erik, Mehran Amir
Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California 90095-6904, USA.
Surg Obes Relat Dis. 2009 Mar-Apr;5(2):203-7. doi: 10.1016/j.soard.2008.10.003. Epub 2008 Nov 1.
To review our experience with early jejunojejunostomy obstruction (JJO) at a large academic teaching hospital and provide a management algorithm. Early JJO is a known and often overlooked complication of laparoscopic Roux-en-Y gastric bypass.
From 2003 to 2007, 1097 patients underwent laparoscopic Roux-en-Y gastric bypass at our institution. Data, including patient demographics, co-morbidities, intraoperative data, peri- and postoperative complications, and outcomes, were prospectively recorded and retrospectively reviewed.
Early post-laparoscopic Roux-en-Y gastric bypass JJO occurred in 13 patients (1.2%). The average time to presentation was 15 days (range 5-27). Patients presented with a combination of nausea, vomiting, and abdominal pain; all underwent computed tomography to confirm the diagnosis. The causes of JJO included dietary noncompliance (46%), anastomotic edema (23%), narrowing of the jejunojejunostomy at surgery (23%), and luminal clot (8%). Management was determined using our proposed treatment algorithm. Three patients (23%) required operative intervention, with the remainder successfully treated conservatively.
From our experience, we propose a treatment algorithm for standardized management of early JJO, reserving reoperation for those who are acutely ill on presentation or those in whom conservative management fails. A review of our series using this algorithm has suggested that most patients can be successfully treated nonoperatively; however, bariatric surgeons must maintain a low threshold for surgical re-intervention in cases in which rapid recovery is not seen.
回顾我们在一家大型学术教学医院处理早期空肠-空肠吻合口梗阻（JJO）的经验，并提供一种管理算法。早期JJO是腹腔镜Roux-en-Y胃旁路手术一种已知但常被忽视的并发症。
2003年至2007年，我院1097例患者接受了腹腔镜Roux-en-Y胃旁路手术。前瞻性记录并回顾性分析包括患者人口统计学资料、合并症、术中数据、围手术期和术后并发症及结局等数据。
13例（1.2%）患者发生了腹腔镜Roux-en-Y胃旁路手术后早期JJO。出现症状的平均时间为15天（范围5 - 27天）。患者表现为恶心、呕吐和腹痛的组合；均接受了计算机断层扫描以确诊。JJO的原因包括饮食不依从（46%）、吻合口水肿（23%）、手术时空肠-空肠吻合口狭窄（23%）和管腔内血栓形成（8%）。采用我们提出的治疗算法确定治疗方案。3例（23%）患者需要手术干预，其余患者经保守治疗成功。
根据我们的经验，我们提出一种用于早期JJO标准化管理的治疗算法，对于就诊时病情严重或保守治疗失败的患者保留再次手术治疗。使用该算法对我们的系列病例进行回顾表明，大多数患者可通过非手术成功治疗；然而，在未见到快速恢复的情况下，减重外科医生对于手术再次干预必须保持较低的阈值。
