Department of Digestive Surgery, Groeninge Hospital, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
Obes Surg. 2011 Dec;21(12):1822-7. doi: 10.1007/s11695-011-0462-6.
Reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass varies between 1.5% and 3.5%. It has been suggested that the antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGB) is associated with a low incidence of internal herniation (IH). Therefore we routinely did not close mesenteric defects. The records of 652 consecutive patients undergoing primary AA-LRYGB from January 2003 to December 2009 in a single institution were retrospectively reviewed to determine the incidence, etiology, clinical symptoms, radiologic diagnostic accuracy and operative outcomes of SBO. Of the 652 patients, 63 (9.6%) developed SBO. The majority (6.9%, 45 patients) had a SBO due to IH. In 41 (91%) cases, the IH was at the jejunojejunostomy (JJ), four cases had an IH at Petersen's space. Adhesions and ventral hernia were found in 14 (2.1%) and four (0.6%) cases, respectively. Twenty-nine out of 63 cases had negative computed tomography (CT) findings and IH was diagnosed on CT in only 33% (14/45) of patients with IH. All patients underwent diagnostic laparoscopy. No bowel resections had to be performed. In contrast to previous reports, a high incidence of SBO with a high rate of IH at the JJ site was found in our series. Accuracy of CT is low and diagnostic laparoscopy is mandatory when SBO is suspected. Since 2010 we have started closing the JJ site, and data on SBO are collected prospectively. We believe that closing of the mesenteric defects is a mandatory step, even in an AA-LRYGB.
据报道，腹腔镜 Roux-en-Y 胃旁路术后小肠梗阻（SBO）的发生率在 1.5%至 3.5%之间。有人认为，胃前结肠前腹腔镜 Roux-en-Y 胃旁路术（AA-LRYGB）与内部疝（IH）的发生率低有关。因此，我们常规不关闭系膜缺损。回顾性分析了 2003 年 1 月至 2009 年 12 月在一家机构中连续进行的 652 例原发性 AA-LRYGB 患者的记录，以确定 SBO 的发生率、病因、临床症状、放射学诊断准确性和手术结果。在 652 例患者中，有 63 例（9.6%）发生了 SBO。大多数（6.9%，45 例）是由于 IH 导致的 SBO。在 41 例（91%）病例中，IH 发生在空肠空肠吻合处，4 例发生在 Petersen 间隙。粘连和腹疝分别在 14 例（2.1%）和 4 例（0.6%）中发现。63 例中有 29 例 CT 检查结果为阴性，在有 IH 的 45 例患者中，IH 仅在 33%（14/45）的患者 CT 上被诊断出来。所有患者均接受了诊断性腹腔镜检查。无需进行肠切除术。与以往报道相比，我们的研究中发现 SBO 发生率高，且 JJ 部位 IH 发生率高。CT 的准确性较低，当怀疑 SBO 时，诊断性腹腔镜检查是必需的。自 2010 年以来，我们开始关闭 JJ 部位，并且前瞻性地收集 SBO 数据。我们认为，即使在 AA-LRYGB 中，关闭系膜缺损也是强制性步骤。
