Department of Surgery, University of Massachusetts Medical School - Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
Surg Endosc. 2020 May;34(5):2204-2210. doi: 10.1007/s00464-019-07009-0. Epub 2019 Aug 5.
Jejunojejunal intussusception after Roux-en-Y gastric bypass (RYGBP) for morbid obesity is a rare but potentially catastrophic complication. There are limited data regarding the incidence of intussusception and the different surgical options for management of this disease.
This is a retrospective review of all patients that underwent RYGBP and subsequently developed intussusception at the jejunojejunostomy. Data were collected between 1/1/2008 and 5/31/2018 and included demographics, details related to the index procedure, presentation, and management of intussusception. Perioperative outcomes and complications were also collected.
665 patients underwent RYGBP. A total of 34 patients developed intussusception, with 31 (4.7%) of them having undergone RYGBP in our hospital. Demographics included age, gender, and BMI at both the index surgery and at the time of intussusception. The jejunojejunostomy was created during RYGBP using a linear stapler in all patients with 64.5% of them achieving a length of 90 mm. All intussuscepted patients presented acutely with abdominal pain. All but one patient required surgical intervention. 42.4% of the patients were found to have intraoperative intussusception which appeared to be retrograde in 78.6% of them. Reduction followed by enteropexy or just enteropexy was performed in 20 patients (60.6%) that required surgery. No immediate post-operative complications were noted but 8 patients (26.5%) had recurrence of intussusception requiring another surgical intervention. In the reoperated group, 75% of the patients were treated with reduction followed by enteropexy or just enteropexy.
This is the largest case series describing jejunojejunal intussusception following RYGBP. All patients that developed intussusception had jejunojejunostomy length greater than 60 mm. The most commonly performed surgical repair was reduction of the intussuscepted segment (if present) followed by enteropexy. Jejunojejunostomy length greater than 60 mm might be associated with the occurrence of intussusception and could explain the higher incidence noted in our series. Minimal intervention with enteropexy can offer effective treatment for most patients.
肥胖症患者行 Roux-en-Y 胃旁路术（RYGBP）后发生空肠空肠套叠是一种罕见但潜在的灾难性并发症。关于套叠的发生率和这种疾病的不同手术治疗选择，数据有限。
这是对所有接受 RYGBP 治疗并随后在空肠空肠吻合口发生套叠的患者进行的回顾性研究。数据收集时间为 2008 年 1 月 1 日至 2018 年 5 月 31 日，包括人口统计学资料、与指数手术相关的细节、表现和套叠的管理。还收集了围手术期结果和并发症。
665 例患者接受了 RYGBP。共有 34 例患者发生套叠，其中 31 例（4.7%）在我院行 RYGBP。人口统计学资料包括指数手术和套叠时的年龄、性别和 BMI。所有患者均在 RYGBP 中使用线性吻合器进行空肠空肠吻合术，其中 64.5%的患者吻合长度为 90mm。所有发生套叠的患者均表现为急性腹痛。除 1 例患者外，所有患者均需手术干预。42.4%的患者术中发现套叠，其中 78.6%的患者套叠呈逆行性。20 例（60.6%）需要手术的患者行复位后肠固定术或单纯肠固定术。无术后即刻并发症，但 8 例（26.5%）患者发生套叠复发，需再次手术干预。在再次手术组中，75%的患者采用复位后肠固定术或单纯肠固定术治疗。
这是描述 RYGBP 后空肠空肠套叠的最大病例系列。所有发生套叠的患者空肠空肠吻合长度均大于 60mm。最常进行的手术修复是复位套叠段（如果存在），然后进行肠固定术。空肠空肠吻合长度大于 60mm可能与套叠的发生有关，这可以解释我们系列中更高的发生率。肠固定术等微创干预措施可为大多数患者提供有效的治疗。
