Late perforation at the jejuno-jejunal anastomosis after laparoscopic gastric bypass for morbid obesity

Abstract

BackgroundAlthough marginal ulceration and perforation at the gastrojejunal anastomosis is an established, albeit rare, risk after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity, little is known about the risk of late perforation at the jejuno-jejunal (J-J) anastomosis. The objective of this study was to identify the incidence of J-J perforation and describe management options and sequelae. MethodsThis is a retrospective review of the database of all patients who underwent LRYGB. The results are presented as mean (range) where appropriate. ResultsBetween April 2002 and April 2012, 1652 patients underwent LRYGB (1577 primary and 75 revision procedures). The operative mortality was .18%. Three patients developed late perforation of the J-J anastomosis (.18%) at 7, 9, and 18 weeks, respectively. Two patients were managed with resection and reanastomosis of the perforation by laparotomy, and a third patient was managed laparoscopically with peritoneal lavage and transcutaneous tube jejunostomy of the perforation. All patients recovered well postoperatively. However, the third patient represented 42 days later with sepsis and died secondary to recurrent J-J ulcer perforation. ConclusionPerforation of the J-J anastomosis is a rare and life-threatening delayed complication after LRYGB and usually presents within 2–8 months postoperatively. It poses difficulties with diagnosis and management and should be dealt with judiciously.