Fibrin Glue and Stents in the Treatment of Gastrojejunal Leaks after Laparoscopic Gastric Bypass: A Case Series and Review of the Literature

Endoscopic retrograde cholangiopancreatography (ERCP) has become an important tool in the diagnosis and treatment of pancreaticobiliary pathology. ERCP in patients that have undergone Roux-en-Y gastric bypass (RYGB) is particularly challenging because traditional transoral endoscopy may be limited. We present our experience with ERCP after RYGB and review the literature. In 2007 eight patients underwent ERCP after RYGB using open or laparoscopic transgastric access. After introduction of pneumoperitoneum, a total of four ports were placed. A purse-string was placed around a gastrotomy 4 to 6cm proximal to the pylorus. The endoscope was introduced through a 15 mm left-upper-quadrant port and the gastrotomy. Endoscopy was then performed. Laparoscopic gastrotomy was used in all patients that underwent a previous laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 6) and open gastrotomy was used for patients with a previous open RYGB (n = 2). Cannulation and interventions in the pancreaticobiliary tree were successful in all cases. There were no postoperative complications. Laparoscopic transgastric ERCP after LRYGB is feasible, highly successful, may be performed expeditiously, and does not seem to add significant morbidity to the procedure. The ability to perform ERCP in this patient population is critical due to their tendency to have preexisting biliary disease and to develop gallstones and the associated complications.

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P78: Early jejunojejunostomy obstructions following laparoscopic gastric bypass: Case series and treatment algorithm

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2008.03.139 ◽

2008 ◽

Vol 4 (3) ◽

pp. 342

Author(s):

Candice M. Jensen ◽

Talar Tejirian ◽

Catherine Lewis ◽

Amir Mehran ◽

Erik Dutson

Keyword(s):

Gastric Bypass ◽

Laparoscopic Gastric Bypass ◽

Treatment Algorithm ◽

Case Series

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Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: case series and review of the literature

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2011.08.008 ◽

2012 ◽

Vol 8 (5) ◽

pp. 641-647 ◽

Cited By ~ 29

Author(s):

Eugene P. Ceppa ◽

Duykhanh P. Ceppa ◽

Philip A. Omotosho ◽

James A. Dickerson ◽

Chan W. Park ◽

...

Keyword(s):

Morbid Obesity ◽

Gastric Bypass ◽

Case Series ◽

Review Of The Literature

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Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2008.10.003 ◽

2009 ◽

Vol 5 (2) ◽

pp. 203-207 ◽

Cited By ~ 23

Author(s):

Catherine E. Lewis ◽

Candice Jensen ◽

Talar Tejirian ◽

Erik Dutson ◽

Amir Mehran

Keyword(s):

Gastric Bypass ◽

Laparoscopic Gastric Bypass ◽

Treatment Algorithm ◽

Case Series

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Small bowel intussusception in pregnant women with a history of a Roux-en-Y gastric bypass: a case series and a systematic review of the literature

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2020.05.019 ◽

2020 ◽

Vol 16 (10) ◽

pp. 1603-1613 ◽

Cited By ~ 1

Author(s):

Daniëlle S. Bonouvrie ◽

Loes Janssen ◽

Hendrik J. Niemarkt ◽

Judith O.E.H. van Laar ◽

Wouter K.G. Leclercq ◽

...

Keyword(s):

Systematic Review ◽

Gastric Bypass ◽

Small Bowel ◽

Pregnant Women ◽

Case Series ◽

Review Of The Literature ◽

Small Bowel Intussusception ◽

History Of

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ROUTINE USE OF V-LOCK® SUTURE FOR BARIATRIC ANASTOMOSIS IS SAFE: COMPARATIVE RESULTS FROM CONSECUTIVE CASE SERIES

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1452 ◽

2019 ◽

Vol 32 (3) ◽

Cited By ~ 2

Author(s):

Claudia BURES ◽

Philippa SEIKA ◽

Christian DENECKE ◽

Johann PRATSCHKE ◽

Ricardo ZORRON

Keyword(s):

Gastric Bypass ◽

Laparoscopic Gastric Bypass ◽

Operative Time ◽

Case Series ◽

Barbed Suture ◽

Gastrojejunal Anastomosis ◽

Morbidly Obese ◽

Group I ◽

Suture Group ◽

Group Ii

ABSTRACT Background: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. Aim: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. Methods: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. Results: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). Conclusion: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.

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