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Case Reports
. 2020 Dec 7;2020(12):rjaa466.
doi: 10.1093/jscr/rjaa466. eCollection 2020 Dec.

Operative approach to intestinal malrotation encountered during laparoscopic gastric bypass

Nicole Shockcor  1 , Rumbidzayi Nzara  1 , Anam Pal  1 , Emanuele Lo Menzo  1 , Mark D Kligman  1
Affiliations
Case Reports

Operative approach to intestinal malrotation encountered during laparoscopic gastric bypass

Nicole Shockcor et al. J Surg Case Rep. .

Abstract

Congenital anomalies of midgut rotation are uncommon with a 0.2-0.5% incidence. Intestinal malrotation (IM) presents a unique challenge in bariatric surgery during laparoscopic gastric bypass (LRYGB), and familiarity with alternatives allows for safe laparoscopic intervention. IM was encountered in 5 of 1183 (0.4%) patients undergoing surgery. Once IM was suspected, a standardized approach was applied: rightward shift of ports, confirmation of IM by the absence of the ligament of Treitz, identification of the duodenojejunal junction, lysis of Ladd's bands, mirror-image construction of the Roux limb and construction of the gastrojejunal anastomosis. Forty percent were male, age 33 ± 8 years, with body mass index 50 kg/m2 (37-75 kg/m2). IM was identified preoperatively in two patients (40%). All operations were completed laparoscopically. Despite the finding of IM, successful laparoscopic completion of gastric bypass can be anticipated if the surgeon has an understanding of the anatomic alterations and a strategy for intraoperative management.

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Figures

Figure 1
Figure 1
Preoperative upper gastrointestinal series.
Figure 2
Figure 2
Port placement during laparoscopic Roux-en Y gastric bypass in setting of malrotation anatomical variant, standard port sites (a) and modified port sites (b).
Figure 3
Figure 3
Anatomy postcompletion of Roux-en Y gastric bypass.
See this image and copyright information in PMC

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