Lazar Damien, Brown Avery, Lipman Jeffrey, Somoza Eduardo, Saunders John, Chui Patricia, Park Julia, Einersen Peter, Peacock Matthew, Chhabra Karan, Parikh Manish
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, United States.
Department of Surgery, New York University Grossman School of Medicine; Bellevue Hospital, New York, United States.
Obes Surg. 2025 Sep 5. doi: 10.1007/s11695-025-08227-3.
Early postoperative small bowel obstruction (ESBO) following roux-en-Y gastric bypass (RYGB) is a feared complication, generally estimated to occur in 1-2% of cases. Most surgeons advocate for prompt surgical exploration for ESBO after RYGB. There is currently a paucity of literature regarding conservative management approaches to ESBO after RYGB.
To determine the safety and efficacy of non-operative management of early small bowel obstruction following RYGB.
Academic-affiliated municipal hospital.
We performed a retrospective review of all patients at a single institution who underwent RYGB between July 1, 2020 and April 30, 2024 and were readmitted within 30 days of the procedure due to a small bowel obstruction. Mesenteric defects were closed with permanent suture in 100% of cases.
2430 RYGBs were performed, 54 patients (2.2%) developed ESBO. The average interval from time of surgery to diagnosis of ESBO was 7.3 days [range 2-26 days]. The vast majority of patients (n = 43; 80%) were successfully managed conservatively including nasogastric decompression (n = 20; 47%). Most (73%) of the patients requiring reoperation were found to have kinking at the anastomosis or dense adhesions from the cut end of the staple line.
This study demonstrates that non-operative management may be a safe and effective treatment option for the majority of RYGB patients who develop ESBO. Clinical judgement is required to identify those who would benefit from early exploration.
胃旁路术（RYGB）后早期术后小肠梗阻（ESBO）是一种令人担忧的并发症，一般估计发生率为1%-2%。大多数外科医生主张对RYGB术后的ESBO进行及时的手术探查。目前关于RYGB术后ESBO保守治疗方法的文献较少。
确定RYGB术后早期小肠梗阻非手术治疗的安全性和有效性。
学术附属市医院。
我们对一家机构中2020年7月1日至2024年4月30日期间接受RYGB手术且术后30天内因小肠梗阻再次入院的所有患者进行了回顾性研究。100%的病例中肠系膜缺损用永久性缝线闭合。
共进行了2430例RYGB手术，54例患者（2.2%）发生了ESBO。从手术到诊断为ESBO的平均间隔时间为7.3天[范围2-26天]。绝大多数患者（n = 43；80%）通过保守治疗成功治愈，包括鼻胃减压（n = 20；47%）。大多数需要再次手术的患者（73%）被发现吻合口处扭结或吻合钉线断端有致密粘连。
本研究表明，非手术治疗可能是大多数发生ESBO的RYGB患者的一种安全有效的治疗选择。需要临床判断来确定哪些患者将从早期探查中获益。
