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OBES SURG (2012) 22:47 DOI 10.1007/s11695-011-0529-4
CLINICAL RESEARCH
Roux Limb Volvulus in Laparoscopic Roux-en-Y Gastric Bypass Due to Roux Limb Stabilization Suture: Case Series
Brendan Marr & Panduranga Yenumula
Published online: 5 October 2011# Springer Science+Business Media, LLC 2011
AbstractBackground Complications after laparoscopic Roux-en-Y gastric bypass surgery may be related to the type of surgical technique employed. One technique, the placement of a Roux limb stabilization suture, presumably prevents kink at the gastrojejunal anastomosis. However, it can have an adverse effect and we studied a series of cases presenting with intestinal obstruction secondary to this stitch. Methods A retrospective review of a prospectively collected database of laparoscopic Roux-en-Y gastric bypass cases who had reoperations for Roux limb volvulus was performed at a single bariatric center by a single surgeon. Results Out of 199 patients who underwent laparoscopic Roux en Y gastric bypass with placement of Roux limb stabilization suture, 4 patients (2.01%) presented with Roux limb volvulus postoperatively. BMI was 45.352.95. The postoperative time to presentation was 1110.6 months. All four patients required surgical exploration to reduce the volvulus. In all cases, the Roux limb volvulus was directly attributable to the presence of the stabilization suture. In subsequent 250 cases where this suture was eliminated, there was no volvulus of Roux limb seen.
Conclusions The use of a stabilization suture can result in volvulus of the Roux limb causing intestinal obstruction and this complication can be prevented by avoiding this suture.
Keywords Laparoscopic Roux-en-Y gastric bypass . Volvulus . Stabilization suture . Complication . Bowel obstruction . Internal hernia
Introduction
With the introduction of laparoscopic Roux-en-Y gastric bypass (LRYGB) in 1994, there was explosive growth of bariatric surgery [1]. LRYGB has become the preferred surgical treatment option for treating morbid obesity. Overall bariatric surgery has demonstrated excellent long-term outcomes [2]. One of the complications from the surgery includes intestinal obstruction. This can result from various causes including volvulus, internal hernia, adhesions, and intussusception. The overall incidence of this complication varies from 1% to 11% [311, 14].
Although the basic tenets of the operation are similar among surgeons, there are a number of technical variations. One of those variations includes the placement of a single suture between the Roux limb and the gastric remnant. The...