COMMENTARY

Does Laparoscopic Gastric Bypass Pose a Higher Risk for Bowel Obstruction?

Albert B. Lowenfels, MD

Disclosures

November 06, 2006

Bowel Obstruction After Open and Laparoscopic Gastric Bypass Surgery for Morbid Obesity

Capella RF, Iannace VA, Capella JF
J Am Coll Surg. 2006;203:328-335

The aim of this single-institution study was to compare the frequency of small bowel obstruction after either open or laparoscopic gastric bypass. The authors compared the frequency of bowel obstruction in 697 patients who had laparoscopic surgery with 735 patients who had open gastric bypass surgery after a minimum follow-up period of a year and a half. Sixty-eight patients in the laparoscopic group had small bowel obstruction requiring readmission and surgery; none of the patients in the open bypass surgery group developed intestinal obstruction. The average time interval from original laparoscopic bypass surgery and readmission of obstruction was about one to one and a half years.

The 10% incidence of small bowel obstruction after laparoscopic gastric bypass surgery is surprisingly high, especially when compared with the absence of intestinal obstruction in the group of patients undergoing open bypass surgery. The authors believe that the open operation leads to the formation of upper abdominal adhesions that fix the bowel and prevent internal hernias through the mesenteric openings created at the initial operation. One drawback of this study is the incomplete follow-up: the authors do not have records of patients with intestinal obstruction who might have been admitted to a different hospital.

Abstract

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