Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome.

ABSTRACT

BACKGROUND: We reported on our experience of 23 patients with retrograde intussusception (RINT) in 2007. That series has increased to 54 patients. Surgical resection of the jejunojejunostomy appears to be the most effective treatment. We treated 8 patients with documented or suspected recurrent RINT despite resection, by reversing their gastric bypass with sleeve gastrectomy to avoid weight regain. METHODS: The medical records of 8 patients who had undergone treatment of suspected recurrent RINT with reversal of their gastric bypass followed by sleeve gastrectomy were reviewed to evaluate the outcomes, complications, weight loss, and relief of symptoms. RESULTS: All 8 patients were women, aged 29-56 years. The mean body mass index at reversal was 22.3-36.5 kg/m(2) (mean 30). The follow-up period was 1-28 months (mean 20.8). The body mass index at the last visit was 21.3-33 kg/m(2) (mean 26). Complications occurred in 5 patients. Patient 1 developed delayed splenic bleeding that required splenectomy on the second postoperative day. Patient 2 developed a gastric fistula 6 weeks after surgery after dilation. Patient 4 developed a superior mesenteric vein thrombosis at 2 weeks postoperatively. Patient 7 developed a proximal small bowel obstruction. Also, 4 patients required dilation of the gastrogastrostomy. At the last follow-up visit, the patients did not have symptoms of recurrent RINT and had not regained their weight. CONCLUSION: Laparoscopic reversal of gastric bypass with sleeve gastrectomy for recurrent RINT or RINT-like symptoms (Roux stasis symptoms) resulted in a significant risk of complications in this small group of patients but appears to be effective for relieving the symptoms of RINT with minimal risk of weight regain, at least in the medium term.