Management of Acute Gastric Remnant Complications After Roux-en-Y Gastric Bypass: a Single-Center Case Series
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Management of Acute Gastric Remnant Complications After Roux-en-Y Gastric Bypass: a Single-Center Case Series Pouya Iranmanesh 1 & Naveen V. Manisundaran 1 & Kulvinder S. Bajwa 1 & Nirav C. Thosani 1 & Melissa M. Felinski 1 & Erik B. Wilson 1 & Shinil K. Shah 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Roux-en-Y gastric bypass is a common bariatric procedure. Its configuration creates an excluded gastric remnant, which is subject to potential acute complications such as bleeding, perforation, and necrosis. Material and Methods A retrospective analysis of a prospective database including all patients presenting between 2007 and 2019 to our institution with acute gastric remnant complications after RYGB was performed. Results Seven patients were included, including 3 hemorrhages, two of which were treated with double-balloon enteroscopy, as well as 3 perforations and 1 necrosis, all of which required emergent surgery. Overall gastric remnant complication rate was 0.3% in this series. Conclusion Acute gastric remnant complications after RYGB are infrequent, but their diagnosis and management can be challenging. Double-balloon enteroscopy has diagnostic and therapeutic value for selected patients. Emergent surgery remains the standard of care for unstable patients and should not be delayed. Keywords Gastric remnant . Bariatric surgery . Roux-en-Y gastric bypass
Introduction The prevalence of obesity has been constantly increasing worldwide in the past 40 years [1]. Bariatric surgery has emerged as one of the most effective treatments for morbid obesity [2]. In the USA, 228,000 bariatric surgery procedures were performed in 2017 [3]. Roux-en-Y gastric bypass (RYGB) remains one of the most commonly performed surgeries in the USA for weight loss with more than 40,500 procedures done in 2017 [3]. During a RYGB, the stomach is divided into a small pouch and a jejunal Roux-en-Y reconstruction is performed. This configuration creates an excluded gastric remnant, which contains the fundus, the antrum, and * Shinil K. Shah [email protected] 1
Department of Surgery, Division of Minimally Invasive and Elective General Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX 77030, USA
2
Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA
most of the gastric body, as well as most of the gastric acidand pepsinogen-producing cells. Access to the gastric remnant for diagnostic or therapeutic purposes is usually not possible with standard endoscopes. Although unusual, acute gastric remnant complications such as bleeding, perforation, and ischemia can occur. Other non-acute complications include gastric remnant tumors and gastro-gastric fistulas [4]. Therapeutic options include mainly surgery as well as double-balloon enteroscopy [5]. This study reports a case series of patients with acute gast
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