Laparoscopic enteropexy for intussusception at Roux-en-Y anastomosis

Abstract

Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure in the world. Jejunojenual intussusception after RYGB is a rare but potentially serious complication. Timely radiographic recognition and surgical therapy with laparoscopic enteropexy of all limbs of the enteroenteric anastomosis in our experience allows same-day management with return to work and activities of daily living without recurrence of intussusception.

Figures 1:

(a) Evidence of intussusception on CT scan (Coronal View). Demonstration of intussusception at the Roux-en-Y enteroenteric anastomosis. (b) Evidence of intussusception on CT scan (Transverse View). Demonstration of intussusception at the Roux-en-Y enteroenteric anastomosis.

Figure 2:

Intussusception. Surgeon manually demonstrating the propensity of the common limb to intussuscept into the anastomosis.

Figure 3:

Anchoring bowel to mesenteric root. Nonabsorbable polyfilament suture placement between bowel and nearby mesenteric root limiting bowel mobility toward the anastomotic junction to prevent intussusception.

Figure 4:

After enteropexy. Demonstration of nonabsorbable suture placement for enteropexy and subsequent inability to intussuscept the common limb into the enteroenteric anastomosis.