NDLI: Late perforation at the jejuno-jejunal anastomosis after laparoscopic gastric bypass for morbid obesity.

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Late perforation at the jejuno-jejunal anastomosis after laparoscopic gastric bypass for morbid obesity.

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Late perforation at the jejuno-jejunal anastomosis after laparoscopic gastric bypass for morbid obesity.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kalaiselvan, Ramya Abu Dakka, Mahmoud Ammori, Basil J.
Description	Country affiliation: United kingdom Author Affiliation: Kalaiselvan R ( Salford Royal Hospital, Manchester, United Kingdom.)
Abstract	BACKGROUND: Although marginal ulceration and perforation at the gastrojejunal anastomosis is an established, albeit rare, risk after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity, little is known about the risk of late perforation at the jejuno-jejunal (J-J) anastomosis. The objective of this study was to identify the incidence of J-J perforation and describe management options and sequelae. METHODS: This is a retrospective review of the database of all patients who underwent LRYGB. The results are presented as mean (range) where appropriate. RESULTS: Between April 2002 and April 2012, 1652 patients underwent LRYGB (1577 primary and 75 revision procedures). The operative mortality was .18%. Three patients developed late perforation of the J-J anastomosis (.18%) at 7, 9, and 18 weeks, respectively. Two patients were managed with resection and reanastomosis of the perforation by laparotomy, and a third patient was managed laparoscopically with peritoneal lavage and transcutaneous tube jejunostomy of the perforation. All patients recovered well postoperatively. However, the third patient represented 42 days later with sepsis and died secondary to recurrent J-J ulcer perforation. CONCLUSION: Perforation of the J-J anastomosis is a rare and life-threatening delayed complication after LRYGB and usually presents within 2-8 months postoperatively. It poses difficulties with diagnosis and management and should be dealt with judiciously.
File Format	HTM / HTML
ISSN	15507289
Issue Number	6
Volume Number	9
e-ISSN	18787533
Journal	Surgery for Obesity and Related Diseases
Language	English
Publisher	Elsevier
Publisher Date	2013-11-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Metabolism Discipline General Surgery Anastomosis, Surgical Adverse Effects Gastric Bypass Intestinal Perforation Surgery Jejunum Obesity, Morbid Adult Methods Databases, Factual Female Follow-up Studies Mortality Hospital Mortality Humans Etiology Laparoscopy Laparotomy Male Middle Aged Diagnosis Reoperation Retrospective Studies Risk Assessment Time Factors Treatment Outcome Journal Article
Content Type	Text
Resource Type	Article
Subject	Surgery

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