Anastomotic Gastro-Jejunal Ulcer Perforation Following One Anastomosis Gastric Bypass: Clinical Presentation and Options of Management-Case Series and Review of Literature

Abstract

Background: One anastomosis gastric bypass (OAGB) is an attractive bariatric procedure compared with the gold standard Roux-en-Y gastric bypass (RYGB) with one less anastomosis. Thousands of these procedures have now been performed by different surgeons who believe that it could hold fewer complications than RYGB. However, postoperative complications including the formation of anastomotic ulcers and possible perforation remain a main concern following OAGB.

Methods: We report three cases of perforation of an ulcer at the gastro-jejunal anastomosis following laparoscopic one anastomosis gastric bypass. All cases needed surgical intervention after adequate resuscitation.

Results: All patients were successfully managed using a minimally invasive approach with different techniques of repair (primary suturing of the perforation or resection and conversion to Roux-En-Y gastric bypass). All patients did well and were discharge in a stable condition after 4-5 days.

Conclusion: Perforation of an anastomotic ulcer post-one anastomosis gastric bypass is a serious condition and can be a life threatening complication. A high index of suspicion helps to diagnose these cases in patients presenting with acute abdomen following OAGB. Adequate resuscitation and repair of the perforation are main lines of treatment. Definitive surgical option depends on the general condition of the patient, timing of presentation, size and site of the perforation, and experience of the surgeon.

Keywords: Anastomosis; Bariatric; Gastro-jejunal; One anastomosis gastric bypass; Perforation.