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Mechanical obstruction may be due to problems inside the bowel, within the wall of the bowel, or forces pushing on the bowel from the outside causing the bowel lumen to close. Tumors can cause bowel obstruction either by pressing on the outside of the bowel and pinching it closed, or by growing within the wall of the intestine and slowly blocking its inner passageway. When there is a structural weakness in the fibers and muscles of the wall of the abdomen, then a portion of the small intestine may protrude through this weakened area, and appear as a lump under the skin. Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, vomiting, and constipation. Methods: Between 1995 and 2001, 711 (246 retrocolic, 465 antecolic) patients underwent a laparoscopic proximal divided roux-en-y gastric bypass via the linear endostapler technique. Results: Etiology of obstruction was internal hernia (6), adhesive bands (5) of which only two was related to prior open surgery, mesocolon window scarring (1), and incarcerated ventral hernia (1). Small bowel obstruction is a known complication after open gastric bypass surgery for morbid obesity.
With the introduction of laparoscopic approaches to gastric bypass, we anticipated there might be a reduction in incision related complications such as wound infections and incisional hernias, and the incidence of post-op small bowel obstruction related to adhesion formation. Between 1995 and 2001, 711 patients underwent a laparoscopic divided roux-en-y gastric bypass via the linear endostapler technique by the first author (JKC) for the indication of morbid obesity. If an antecolic technique is employed, a window is made in the greater omentum just anterior to the transverse colon and the end on the roux limb is passed antecolic and antegastric. If a retrocolic technique is employed, a window is created in the transverse mesocolon, just superior and lateral to the ligament of Trietz. After the roux limb is passed to the upper abdomen the patient is re-positioned back in extreme reverse trendelenburg and the gastro-jejunostomy is performed.
Patients are placed on ice chips overnight  and advanced to clear liquids on post-op day one. Patients are seen at 3 weeks, 3 months, 6 months, 12 months, and yearly there after for life. Statistical significance was determined by Fisher’s exact test and Pearson or likelihood ratio Chi-Square test.
One antecolic patient required conversion to an open technique early in the series because the stapler at that time was too short to transect the stomach at the fundus, and three were converted to a retrocolic position due to extreme mesenteric shortening. There was one death (7.7%) secondary to a pulmonary embolus post-op after an open conversion for management of a non-sutured mesenteric defect internal hernia in a 60 year-old male, with a BMI of 60, despite prophylaxis with fractioned heparin and sequential compression hose. Overall there were 13 (1.8%) small bowel obstructions and internal hernias as listed in Table 1.
Seven obstructive patients (55%) had undergone previous open abdominal surgery, which was the same incidence as the overall cohort. Our overall incidence of small bowel obstruction after a laparoscopic gastric bypass was similar to reports of open bypass, which surprised us initially. We initially began performing the laparoscopic gastric bypass by utilizing an antecolic approach, with no suture closure of mesenteric defects, as we were taught in our training on the open bypass. We analyzed and reported our early outcomes in 2001, after accumulating a sufficient antecolic experience, to determine if there truly was more tension on the antecolic limb placement, with a resulting higher incidence of anastamotic strictures or leaks, or if the incidence of small bowel obstructions was altered.8 Our early results demonstrated a lower incidence of stenosis of the gastro-jejunostomy in the antecolic group, which was not significant, and no difference in incidence of leaks between techniques. The other observations we experienced were the antecolic technique was technically easier to perform and teach, than passing the roux limb posterior, and resulted in approximately a 20-minute shorter operating room time.
Of interest is the fact we experienced no obstructions at the entero-enterostomy site in this study, which has been reported as a common etiology after laparoscopic gastric bypass10. This paper reports an incidence of small bowel obstruction overall of 1.8% after laparoscopic gastric bypass, which was similar to reports from open surgery, but internal hernias were more common. Intestinal Bowel Support consists of herbs and amino acids that help to heal and support the intestinal tract lining. Take 2 capsules in the morning on an empty stomach (30 minutes before eating) and 2 capsules in the evening on an empty stomach (3 hours after eating). Contains no nuts, peanuts, sesame seeds, mustard seeds, wheat, gluten, yeast, corn, egg, dairy, soy, crustaceans, shellfish, fish, animal products, artificial colour, or preservatives, binders or fillers. Intestinal Bowel Support is comprised of ingredients to provide enhanced support to heal and repair the intestinal tract lining, while at the same time, relieve cramping, spasms, and irritation of the intestinal tract and colon.
Intestinal Bowel Support consists of powdered herbs and amino acids delivered in vegetable capsules. Intestinal Bowel Support helps to heal and support the intestinal tract lining, while at the same time, relieve cramping, spasms, and irritation of the intestinal tract and colon. If you have a question that has not been answered here, please fill out the form below and one of our customer service representatives will respond to you. I found you product "Intestinal Bowel Support" at a local health food store, and am pleased with the results of only 4 days, I'm starting to feel normal again which hasn't happened in years.
Receive insightful articles, upcoming events, andmoney saving coupons on your favourite products! Receive insightful articles, upcoming events, and money saving coupons on your favourite products! If posting a message by using a HTML editor (FCK or MCE), you will have to use the appropriate buttons (Insert Image) from the editor toolbar. Our award-winning blog brings you insights on health, nutrition and wellness from experts you can trust. The large bowel, also called the large intestine, is a part of your body that helps you remove waste.
Large bowel (intestinal) obstruction occurs when there is a blockage in the large bowel that prevents food from passing through. Note: Fewer than one in three colorectal cancer patients actually develop large bowel obstruction. Physical exam: The doctor will check to see if you have abdominal pain, vomiting, or any movement of gas or stool in the bowel. Electrolyte panel: A blood test that measures the levels of electrolytes, such as sodium, potassium, and chloride. Urinalysis: A test to check the color of urine and its contents--such as sugar, protein, red blood cells, and white blood cells--is performed.
Barium enema: A liquid that contains barium (a silver-white metallic compound) is put into the rectum. CT (computed tomography--also called CAT) scan: This scan makes detailed pictures of areas inside of the body. Fluid replacement therapy: A treatment to get the fluids in the body back to normal amounts.
Electrolyte correction: A treatment to get the right amounts of chemicals in the blood, such as sodium, potassium, and chloride. Catheter (flexible plastic tube that is placed into your bladder to drain urine) can travel around in the body.


Emergency surgery has a high risk of death, especially for the elderly with other health problems. This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. The symptoms of obstruction will depend on whether the small or large intestine is involved. Adhesions most commonly form in the abdomen after abdominal inflammation caused by abdominal surgery, infection, or injury. Many cases are not treated surgically, but bowel obstruction is a medical emergency and is considered a surgical problem.
This paper reviews our experience with small bowel obstruction after laparoscopic roux-en-y gastric bypass. Thirteen patients (1.8%) developed a small bowel obstruction requiring surgical intervention. A significant decrease in occurrence was noted after adoption of an antecolic placement of the roux limb. There were 604 females and 107 males, average age 38 (range 16-64), mean weight of 136 kg (range96-250), and mean BMI of 51 (range 38-80). If the greater omentum is especially thin, the roux limb can be passed anterior without a window.
The roux limb is passed manually with a grasper behind the colon and stomach to the transected pouch. The side of the roux limb is sutured to the anterior edge of the gastric pouch with two extracorporeal permanent sutures.
Patients are discharged routinely on post-op day two on a liquid diet for two weeks, soft diet for three weeks and advance to regular diet at six weeks. Missed appointments are followed up with phone calls and certified letters to maintain contact. Three retrocolic patients required conversion to a hand assisted technique due to difficulty passing the roux limb retrocolic.
There were six internal hernias, five adhesive obstructions, one mesocolon window scarring with partial obstruction, and one incarcerated ventral hernia. Only two adhesive obstructions were related to prior open surgery, as demonstrated by the presence of distal small bowel adhesions at re-exploration, which were not addressed at the bariatric procedure.
On closer review we observed a higher occurrence of internal hernias, and fewer adhesive obstructions, which we speculate is due to less internal trauma with a minimally invasive approach in our experience. After 53 cases we changed to a retrocolic approach because we were criticized by surgeons who claimed a retrocolic limb placement would result in less tension on the gastro-jejunostomy due to a shorter path, and would result in less anastamotic strictures and leaks. We observed a difference at re-operation in the appearance of sutured versus non-sutured retrocolic bypasses. The difference in incidence of small bowel obstruction was significant even in early outcomes, with the antecolic cohort being lower, and this has held up with doubling the antecolic cohort sample. In addition, upon re-exploration, the roux limb and gastro-jejunostomy is readily visible anteriorly, where as we have to open the gastro-colic ligament and explore the lesser sac to determine if there is an anastamotic leak or mesocolon internal hernia with the retrocolic limb placement. Early obstructions occurred from three days to three months post-op, and late obstructions occurred one to three years post-op and are predominantly internal hernias. We attribute this to our technique for the distal anastomosis whereby we utilize two permanent stay sutures to align the bowel, and we close the stapler enterotomy with a hand sewn suture to prevent compromise of the stoma despite the fact we construct the side to side stoma with only one firing of a 45mm linear stapler.. Our incidence of obstruction after laparoscopic retrocolic gastric bypass was not altered by suture closure of mesenteric defects.
Laparoscopic gastric bypass, roux-en-y: the results in 500 patients with 5-year follow-up.
Internal hernias after laparoscopic gastric bypass: incidence, treatment, and prevention. It also includes a mixture of herbal ingredients that help to relieve cramping, spasms, and irritation of the intestinal tract and colon. Those with severe symptoms may feel relief after the first few days, although it will take a longer period of time for long term relief. Our mission is to empower each and every one of our valued customers with the knowledge to improve their overall health through optimum digestive function and superior nutrition.
An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
These medications can be used to treat pain, nausea, fullness of bowel, or more than one symptom.
This is not true for people in the advanced stages of cancer and the elderly with other health problems because they cannot withstand surgery. An adhesion, if it constricts the lumen of the bowel, may cause blocking (obstruction) of intestinal flow. The section of small intestine that becomes a hernia can become obstructed if it is trapped or tightly pinched at the point where it pokes through the abdominal wall. If you believe you have a bowel obstruction, then contact your healthcare provider or go to your nearest emergency room immediately. The etiology of small bowel obstruction after bariatric surgery includes internal hernias, which may occur at Petersen’s space, the mesocolon window, or entero-enterostomy mesenteric defect, adhesions (simple or closed loop), incarcerated ventral hernias, and rarely an intussusception of the entero-enterostomy. Fifty five percent of patients had undergone a previous open abdominal procedure for a non-obesity indication. If defects are closed a 2-0 silk is begun at the base of Petersen’s defect and run superior over the roux limb incorporating the bowel serosa and also closing the mesocolon window to the medial edge of the defect. This results in fewer adhesions to prevent internal hernias, so the ratio between internal hernias and adhesive etiologies is altered. During the initial antecolic trial we didn’t witness any small bowel obstructions, or internal hernias over an 18-month time frame. The running suture utilized to close the defects pulled the roux limb and entero-enterostomy close together, and each of the proximal adhesive obstructions occurred as a result of adhesions between the roux limb and the entero-enterostomy site.
In addition, Felix10 has demonstrated the resultant reduction in incidence of obstruction between antecolic and retrocolic techniques by the same surgeon in his recent report.
The diagnosis of internal hernia can be difficult and radiologic evaluation is often non-diagnostic. We demonstrated a significant reduction in incidence of obstruction with an antecolic placement of the roux limb without suture closure of mesenteric defects and it is now our preferred technique for laparoscopic gastric bypass. Two main nutrients are necessary to rebuild the intestinal lining; L-Glutamine and N-acetyl glucosamine. For those with mild to moderate symptoms, relief may take from a few days to a few weeks after starting the program. We accomplish this goal by providing safe and effective natural solutions to digestive care issues through our innovative product line and continued commitment to education.


When this happens, the pressure causes a leak that spreads bacteria into the body or blood. It allows the transmission of an image of the colon lining onto a screen for the doctor to view.
With tenesmus, you feel like you need to pass stools, even though your bowels are already empty. In extreme cases, the pinched intestine also may "strangulate," meaning the blood supply is cut off. All changes made to improve a technique will result in some adverse effect, which may not be apparent for some time. Patient selection criteria followed National Institutes of Health Consensus Statement 1991 guidelines for surgical management of morbid obesity.
Insufflation is begun at 15mm Hg and careful inspection made to rule out any trocar injury. The mesenteric defect at the entero-enterostomy is closed with a second 2-0 silk, which is begun on the bowel edge and run inferiorly to the base of the mesentery.
A 30 cm linear stapler with a 3.5 mm staple is inserted half way and fired to create the anastomosis.
Two cases were converted to open: A distal adhesion with ischemic bowel, which required resection, and an internal hernia at the mesenteric defect. As we adopted the retrocolic, retrogastric limb placement, we did not initially suture close the mesenteric defects, again following our practice with open bypass. These observations, coupled with long-term follow-up of our initial antecolic group who still had no obstructions after four years, led us to revert back to an antecolic-antegastric placement of the roux limb with no suture closure of mesenteric defects in 2000. The distance is shorter for the retrocolic limb passage, and we have had to utilize the retrocolic route in three cases where we attempted an antecolic passage due to a shortened mesentery, however, this increase in distance does not appear to be clinically significant in our experience. The occurrence of abdominal colic after laparoscopic gastric bypass should raise suspicion of an obstruction, and if symptoms persist, or recur, an exploration is in order.
Intestinal Bowel Support works to sooth and heal the damaged areas of the intestinal tract and its lining by providing the body with a therapeutic dose of L-Glutamine as well as N-Acetyl-Glucosamine.
This paper is a retrospective review of one surgeons experience with small bowel obstruction after laparoscopic roux-en-y gastric bypass, and the modifications employed to reduce its incidence over a seven-year period.
Patients were considered candidates if they were 100 pounds over ideal body weight as determined by the Metropolitan Life Insurance tables, or had a BMI of 40 or greater if they had no co-morbidities; and patients could be considered if their BMI was 35-39 if they had a significant associated health problem.
The remaining four 5mm trocars and one 12mm trocar are inserted under direct visualization.
A 30 Fr blunt tipped bougie is carefully passed by anesthesia across the anastomosis and the enterotomy is closed around the bougie with a running 2-0 silk suture. We again didn’t experience an obstruction post operatively for over two years with the retrocolic non-sutured approach; however, we quickly observed and treated three internal hernias in a six-week period, at each of the three mesenteric defects (Petersen’s space, mesocolon window, mesenteric defect), and several more followed over time. It is important for all laparoscopic bariatric surgeons to be proficient in the retrocolic technique in the event it must be utilized. This exploration can usually be done laparoscopically, as we have demonstrated, in experienced hands. This formula also provides ingredients which help to reduce inflammation and promote healing in the intestinal tract. Overall 246 patients underwent a retrocolic placement of the roux limb and 465 had an antecolic position as the technique evolved. With the patient positioned in extreme reverse trendelenburg position a 5mm Allis clamp is inserted via an epigastric trocar and positioned under the liver and attached to the diaphragm to provide exposure.
Therefore, after 149 non-sutured retrocolic bypasses we changed our technique to incorporate suture closure of the mesenteric spaces with a running silk suture to try and eliminate internal hernias.
An obstruction after gastric bypass can result in a closed loop obstruction, which can be lethal; therefore, if a patient appears ill or septic, an immediate exploration is in order without delaying for a diagnostic work-up.
The initial 53 patients were performed by placement of the roux limb antecolic- antegastric. To our surprise we continued to observe small bowel obstructions in the sutured group, but half were adhesive which presented early (1-3 months post-op) and half were internal hernias that presented late (1-3 years post-op) after significant weight loss.
The next 246 patients underwent retrocoloic-retrogastric placement of the roux limb, with 149 not having the mesenteric defects closed, and 97 had defects sutured. An endoscopic ruler is then used to measure 5cm from the angle of His along the lesser curve to construct the vertically oriented pouch. Therefore, suture closure of mesenteric defects reduced but did not eliminate internal hernias in our experience. Despite our aggressive approach, and policy of prompt exploration, we experienced one ischemic closed loop obstruction that required resection, and had one death (7.7%)secondary to a pulmonary embolus.
A window is created along the lesser curve into the lesser sac at the 5cm mark by blunt dissection in order to position the stapler for the pouch construction. In the seven obstructions in the non-sutured cohort there were five internal hernias (71%) and two adhesive obstructions, both of which were distal obstructions from previous open pelvic surgery.
A 45 mm linear cutter with a 3.5mm staple is then positioned and fired horizontally on the lesser curve to begin pouch formation. A 50 Fr blunt tip bougie is passed along the lesser curve and placed gently against the staple line. The stapler is repositioned vertically alongside the bougie and fired vertically up through the angle of His to complete the transection of the pouch. The pouch is calibrated in this method to hold 20cc, and has been measured intra-operatively. The patient is re-positioned supine and the greater omentum is retracted superiorly and the ligament of Trietz identified. The bowel is measured 40 cm distal to the ligament with an endoscopic ruler and transected with a linear endoscopic 60mm stapler with 2.5 mm staples. The mesentery is lengthened with one or two firings of a 45 mm linear stapler with 2.0 mm staples.
A measurement is then made an additional 60 cm if the BMI is 40, 80cm if he BMI is 50, and 110 cm if the BMI is 60 as a general guide. The distal jejunum is sutured to the proximal jejunum with two stay sutures of permanent suture placed via an extracorporeal technique. An enterotomy is made on the ante-mesenteric border of the bowel between the two sutures, and a linear 45 cm stapler with 2.5 mm staples is inserted and fired to create a side-to-side entero-enterostomy.



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