Anastomotic Gastro-Jejunal Ulcer Perforation Following One Anastomosis Gastric Bypass: Clinical Presentation and Options
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Anastomotic Gastro-Jejunal Ulcer Perforation Following One Anastomosis Gastric Bypass: Clinical Presentation and Options of Management—Case Series and Review of Literature Bassem Abou Hussein 1
&
Omar Al Marzouqi 1 & Ali Khammas 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background One anastomosis gastric bypass (OAGB) is an attractive bariatric procedure compared with the gold standard Rouxen-Y gastric bypass (RYGB) with one less anastomosis. Thousands of these procedures have now been performed by different surgeons who believe that it could hold fewer complications than RYGB. However, postoperative complications including the formation of anastomotic ulcers and possible perforation remain a main concern following OAGB. Methods We report three cases of perforation of an ulcer at the gastro-jejunal anastomosis following laparoscopic one anastomosis gastric bypass. All cases needed surgical intervention after adequate resuscitation. Results All patients were successfully managed using a minimally invasive approach with different techniques of repair (primary suturing of the perforation or resection and conversion to Roux-En-Y gastric bypass). All patients did well and were discharge in a stable condition after 4–5 days. Conclusion Perforation of an anastomotic ulcer post-one anastomosis gastric bypass is a serious condition and can be a life threatening complication. A high index of suspicion helps to diagnose these cases in patients presenting with acute abdomen following OAGB. Adequate resuscitation and repair of the perforation are main lines of treatment. Definitive surgical option depends on the general condition of the patient, timing of presentation, size and site of the perforation, and experience of the surgeon. Keywords One anastomosis gastric bypass . Perforation . Anastomosis . Gastro-jejunal . Bariatric
Introduction Laparoscopic one anastomosis gastric bypass (OAGB) surgery is a safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently [1]. The technical simplicity (Fig. 1) and quickness of this operation with the
* Bassem Abou Hussein [email protected] Omar Al Marzouqi [email protected] Ali Khammas [email protected] 1
General Surgery Department, Rashid Hospital-DHA, Oud Meitha Street, PO Box: 4545, Dubai, United Arab Emirates
effective weight loss results and amelioration of the comorbidities have played a role in a remarkable recent success [2–4]. The risk of symptomatic (bile) reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and esophageal cancers is some of the commonly voiced concerns [5]. Many articles have described anastomotic ulcers at the gastro-jejunal anastomosis, but few cases have been reported describing perforation of these ulcers and options of management. We report three cases of anastomotic gastro-jejunal ulcer perforation following OAGB that were successfully treated by a minimally invasive approach
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