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Background <p>Early postoperative small bowel obstruction (ESBO) following roux-en-Y gastric bypass (RYGB) is a feared complication, generally estimated to occur in 1–2% of cases. Most surgeons advocate for prompt surgical exploration for ESBO after RYGB. There is currently a paucity of literature regarding conservative management approaches to ESBO after RYGB.</p> Objectives <p>To determine the safety and efficacy of non-operative management of early small bowel obstruction following RYGB.</p> Setting <p>Academic-affiliated municipal hospital.</p> Methods <p>We performed a retrospective review of all patients at a single institution who underwent RYGB between July 1, 2020 and April 30, 2024 and were readmitted within 30&#xa0;days of the procedure due to a small bowel obstruction. Mesenteric defects were closed with permanent suture in 100% of cases.</p> Results <p>2430 RYGBs were performed, 54 patients (2.2%) developed ESBO. The average interval from time of surgery to diagnosis of ESBO was 7.3&#xa0;days [range 2–26&#xa0;days]. The vast majority of patients (<i>n</i> = 43; 80%) were successfully managed conservatively including nasogastric decompression (<i>n</i> = 20; 47%). Most (73%) of the patients requiring reoperation were found to have kinking at the anastomosis or dense adhesions from the cut end of the staple line.</p> Conclusions <p>This study demonstrates that non-operative management may be a safe and effective treatment option for the majority of RYGB patients who develop ESBO. Clinical judgement is required to identify those who would benefit from early exploration.</p>

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Strategies for Conservative Management of Early Post-Operative Obstruction Following Roux-en-Y Gastric Bypass

  • 期刊论文

  • 发表日期：

    2025年9月5日

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  • Damien Lazar,
  • Avery Brown,
  • Jeffrey Lipman,
  • Eduardo Somoza,
  • John Saunders,
  • Patricia Chui,
  • Julia Park,
  • Peter Einersen,
  • Matthew Peacock,
  • Karan Chhabra,
  • Manish Parikh

摘要

Background

Early postoperative small bowel obstruction (ESBO) following roux-en-Y gastric bypass (RYGB) is a feared complication, generally estimated to occur in 1–2% of cases. Most surgeons advocate for prompt surgical exploration for ESBO after RYGB. There is currently a paucity of literature regarding conservative management approaches to ESBO after RYGB.

Objectives

To determine the safety and efficacy of non-operative management of early small bowel obstruction following RYGB.

Setting

Academic-affiliated municipal hospital.

Methods

We performed a retrospective review of all patients at a single institution who underwent RYGB between July 1, 2020 and April 30, 2024 and were readmitted within 30 days of the procedure due to a small bowel obstruction. Mesenteric defects were closed with permanent suture in 100% of cases.

Results

2430 RYGBs were performed, 54 patients (2.2%) developed ESBO. The average interval from time of surgery to diagnosis of ESBO was 7.3 days [range 2–26 days]. The vast majority of patients (n = 43; 80%) were successfully managed conservatively including nasogastric decompression (n = 20; 47%). Most (73%) of the patients requiring reoperation were found to have kinking at the anastomosis or dense adhesions from the cut end of the staple line.

Conclusions

This study demonstrates that non-operative management may be a safe and effective treatment option for the majority of RYGB patients who develop ESBO. Clinical judgement is required to identify those who would benefit from early exploration.