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Up to 5% of patients may present with abdominal pain after a Roux-en-Y Gastric Bypass. Etiology is diverse: correlation of clinical manifestations and imaging / endoscopic findings leads to diagnosis but in some cases surgical evaluation is needed to diagnose and treat. In this video we can see an Exploratory laparoscopy after a Roux-n-Y Gastric Bypass.
This technique remains the gold standard for treatment of morbid obese patients and their comorbidities. The anatomical changes produced may lead to episodes of small bowel occlusion due to internal hernias. Surgical revision of these patients requires in-depth knowledge of the primary procedure and excellent anatomical orientation. This case illustrates the laparoscopic revision for internal hernia after a Roux-n-Y gastric bypass.
The rate of revisional bariatric surgeries is increasing. The anatomy of these patients is already altered by previous surgical procedures. Prevention of classic issues may lead to unexpected complications. This case involves a patient who developed an internal hernia in the immediate postoperative period at an unusual site.
Bleeding from the stapling line or into the abdominal cavity may occur after a sleeve gastrectomy and may be difficult to manage. Extraluminal hemorrhage often occurs dramatically, as a hypovolemic shock requiring immediate resuscitation. The differential diagnosis with pulmonary embolism and myocardial infarction is crucial. If gastrointestinal bleeding is suspected, the test of choice is an endoscopy. If there is a massive extraluminal haemorrhage, an emergency reoperation would have to be performed.
Cases of abdominal pain in patients with previous gastric bypass should be carefully assessed as etiology is multiple. Small bowel occlusion is the most common cause in these patients. A combination of high clinical suspicion, prompt diagnosis, and treatment may avoid severe complications such as intestinal ischemia, perforation, peritonitis and sepsis. Jejuno jejunal intussusception can be one of these causes, as you can see in the video.
Finally a patient with choledocholithiasis after a gastric bypass is managed by a gastrostomy of the remnant stomach to allow the introduction of an endoscopy and perform an Endoscopic Retrograde Cholangiopancreatogram to drain the biliary system and a simultaneous cholecystectomy.
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