1. In the name of GOD

2. Gastrointestinal Obstruction After Bariatric Surgery

3. understanding of the anatomy of RYGB
Obstruction After Roux-En-Y Gastric Bypass
understanding of the anatomy of RYGB

4. Roux-en Y gastric bypass

5. obstruction of the Roux limb or common channel
nausea,
vomiting,
food intolerance,
abdominal pain,
distention.

6. Obstruction of the biliopancreatic limb
abdominal fullness,
bloating,
hiccups,
pain

7. ( a ) This plain fi lm of a gastric bypass patient with obstruction of the biliopancreatic limb is not particularly revealing. ( b ) CT imaging of the same patient reveals a tremendously enlarged gastric remnant fi lled with fl uid. The antegastric Roux limb containing a small amount of contrast can be appreciated anteriorly

8. Gastrojejunal Stricture
a significant majority of gastrojejunal strictures present within the first 90 days after surgery,
Some patients may present much later, even a year or more postoperatively

9. etiology of gastrojejunal stricture
switching from a 21 mm circular stapler to a 25 mm circular stapler reduced
the rate of stricture by a factor of 3, from 27 to 9 %
firm apposition or compression of the tissue edges may be helpful
a circular stapler with 3.5 mm staple height resulted in a lower stricture rate than
one with 4.5 mm staples
The use of staple line reinforcement materials has also been shown to
reduce stricture rate

10. Diagnosis :
History
Upper Endoscopy
Radiographic Contrast

11. Treatment
Balloon Dilation

12. Obstruction from Internal hernia
the single most common cause of bowel obstruction in their gastric bypass patients, representing 41 % of all obstructions

13. ANTECOILC ROUX LIMB DISTAL ANASTOMOSIS MESENTERIC HERNIA
PETERSEN HERNIA

14. Retrocolic gastric bypass
Mesocolic Hernia

15. Sign and symptoms
Severe abdominal pain far out of proportion to the physical exam findings
Intense pain in the midepigastrium, often radiating to the back

16. Plain film of a patient with an incarcerated internal hernia, showing dilated small bowel loops.
Bowel obstruction may or may not be present with internal hernia
Petersen-type internal hernia after biliopancreatic diversionwith duodenal switch, resulting in irreversible small bowel ischemia

17. Small Bowel Obstruction from Scars and Adhesive Bands
adhesions were the second most common source of obstruction (22 %)
after internal hernia (42 %)

18. Incisional Hernia trocar site umbilical hernia site
Previous open incision site

19. Intussusception

20. Obstruction from Intraluminal Blood Clot or Bezoar

21. General Approach to the Bypass Patient with Obstruction
CT imaging with oral and IV contrast
plain films and upper gastrointestinal (UGI) series
Nasogastric tube

22. Obstruction in the Laparoscopic Adjustable Gastric Band Patient
Early Postoperative Band Obstruction
Late Postoperative Band Obstruction
Unusual Types of Band Obstruction

23. Laparoscopic adjustable gastric band

24. ( a ) Plain film of the abdomen showing normal positioning of a gastric band. An upward angulation of the left side of the band of 30–45° is normal.
( b ) Esophagram showing normal positioning of a gastric band. This band is not yet filled and causes minimal holdup of contrast through the band. The band is angulated with the left side up about 30°, which is normal

25. Esophagram showing a slipped band with posterior gastric prolapse
Esophagram showing a slipped band with posterior gastric prolapse. Note the near- vertical orientation of the band and the excessively large stomach pouch

26. Obstruction After Sleeve Gastrectomy

27. Obstruction After Biliopancreatic Diversion with Duodenal Switch

28. The End