Abstract
BackgroundSmall bowel obstruction after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. However, patients who need re-operation for this complication have a high rate of postoperative complications.We report a case series of three patients who underwent fluoroscopic balloon dilation (FBD) for early jejunojejunostomy obstruction (JJO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction).Case presentationThree patients were referred to our hospital for surgery for gastric cancer. Robot-assisted distal gastrectomy with D2 lymph node dissection and antecolic R-Y reconstruction were performed in two patients, and robot-assisted total gastrectomy with D1+ lymph node dissection and antecolic R-Y reconstruction was performed in one patient. The jejunojejunostomy was created as a side-to-side anastomosis using a linear 45-mm stapler. The entry hole was closed with a knotless barbed suture, and serosal-muscle layer suture reinforcement with an absorbable suture was performed at the jejunojejunostomy.Subsequently, all the patients were diagnosed with JJO by computed tomography and upper gastrointestinal series. The average time to JJO from gastrectomy was 5 days (range 2–7); initial clinical symptoms were vomiting in all three cases, with simultaneous upper abdominal pain in one case. We successfully performed FBD in all three cases after unsuccessful conservative treatment using an ileus tube. The clinical symptoms improved soon after FBD, and all the patients were able to avoid re-operation. The average period to FBD from JJO was 10 days (range 4–14). The average procedure time was 46 min (range 29–68), and the average duration to oral intake from FBD was 4 days (range 2–5). The average duration of hospital stay after FBD was 12 days (range 9–15). There were no complications in any of the cases.ConclusionFBD might be a feasible procedure to avoid surgery for early small bowel obstruction after gastrectomy with R-Y reconstruction.
Highlights
Small bowel obstruction (SBO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication
Small bowel obstruction (ESBO) within the first 30 postoperative days after the reconstructive surgery can be caused by technical problems, such as kinking, narrowing, or acute angulation of the anastomosis, while late SBO can occur secondary to internal hernia or intra-abdominal adhesions [1, 2]
Most patients diagnosed with Early small bowel obstruction (ESBO) after R-Y reconstruction are observed conservatively and do not require surgical intervention [1,2,3,4]
Summary
Small bowel obstruction (SBO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. We report three cases in which fluoroscopic balloon dilation (FBD) was successfully performed to avoid reoperation for early jejunojejunostomy obstruction (JJO) after gastrectomy with R-Y reconstruction. His clinical symptoms improved on the day following FBD. Oral intake was commenced 5 days after FBD, and he was discharged 11 days after FBD He experienced no symptoms or other complications during the 60 days follow-up period. Insertion of an ileus tube for decompression and bowel rest was performed, but without symptom improvement. His clinical symptoms improved on the day following FBD, and oral intake was commenced 2 days after FBD. The ileus tube was removed after confirming improvement of abdominal findings and bowel evacuation
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