In many centers, laparoscopic Roux-en-Y gastric bypass has become the most common bariatric procedure for morbid obesity.
In this operation, the stomach is stapled or divided to form a small pouch (typically <30 mL in volume), which empties into a Roux limb of the jejunum of varying length (typically 75-150 cm).
The Roux limb may be brought up to the gastric pouch in two ways:
- anterior to the transverse colon (antecolic-anterogastric)
- posterior to the transverse colon (retrocolic-retrogastric)
There are two anastomoses: a proximal gastrojejunal anastomosis and a distal jejunojejunal anastomosis.
Although any visible defects that might allow potential bowel herniation are routinely closed at surgery 2, the antecolic approach has become preferred at some centers because a retrocolic approach requires bringing the Roux limb through the mesenteries and markedly increases the rate of an internal hernia.
Early complications of gastrointestinal complications of gastric bypass surgery include 3:
- anastomotic leak: usually at the gastrojejunal anastomosis
- acute ischemia
- anastomotic narrowing/stenosis/stricture
- most common cause of postoperative nausea and vomiting
- may require lateral or steep oblique views to visualize
- rare at jejunojejunal anastomosis (0.9%)
- bezoar formation in the gastric pouch
- hemorrhage / hematoma
- adhesions / small-bowel obstruction
- internal hernia 2
- small bowel intussusception, retrograde much more often than antegrade 5-7
History and etymology
The Roux-en-Y is named after the Swiss surgeon César Roux (1857-1934), who was Chief of Surgery at the county hospital of Lausanne and following the opening of the new University of Lausanne, in 1890, was its inaugural Professor of External Pathology and Gynecology 4.
- 1. Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am. J. Surg. 2002;184 (6B): 9S-16S. Am. J. Surg. (link) - Pubmed citation
- 2. Lockhart ME, Tessler FN, Canon CL et-al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007;188 (3): 745-50. doi:10.2214/AJR.06.0541 - Pubmed citation
- 3. Blachar A, Federle MP, Pealer KM et-al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223 (3): 625-32. doi:10.1148/radiol.2233011323 - Pubmed citation
- 4. Hutchison RL, Hutchison AL. César Roux and his original 1893 paper. (2010) Obesity surgery. 20 (7): 953-6. doi:10.1007/s11695-010-0141-z - Pubmed
- 5. Mocanu SN, Botey Fernández M, Simó Alari FB, García San Pedro Á. Acute anterograde intussusception as a late complication of distal gastric bypass. (2018) Journal of surgical case reports. 2018 (9): rjy248. doi:10.1093/jscr/rjy248 - Pubmed
- 6. Boccalatte LA, Achaval Rodríguez J, Beskow A, Cavadas D, Fernando W. Intussusception as a complication of bariatric surgery in pregnant patients: report of one case and revision of the literature. (2017) Journal of surgical case reports. 2017 (10): rjx189. doi:10.1093/jscr/rjx189 - Pubmed
- 7. Khan K, Saeed S, Persaud A, Sbeih M, Gray S, Ahmed L. Retrograde jejunojejunal intussusception in a pregnant female after laparoscopic Roux-en-Y gastric bypass. (2018) Journal of surgical case reports. 2018 (5): rjy094. doi:10.1093/jscr/rjy094 - Pubmed