Original article Roux limb obstruction secondary to constriction at transverse mesocolon rent after laparoscopic Roux-en-Y gastric bypass Ahmed R. Ahmed, M.D., F.R.C.S. (Gen.Surg.) a, *, Gretchen Rickards, M.D. a , Susan Messing, M.A., M.S. b , Syed Husain, M.D. a , Joseph Johnson, M.D., F.A.C.S. a , Thad Boss, M.D., F.A.C.S. a , William O’Malley, M.D., F.A.C.S. a a Department of Bariatric Surgery, University of Rochester Medical Center, Rochester, New York b Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York Received November 17, 2007; revised January 29, 2008; accepted February 7, 2008 Abstract Background: Partial small bowel obstruction can occur as a result of circumferential extrinsic compression of the Roux limb as it traverses the transverse mesocolic rent from thickened cicatrix formation in this area. The aim of this study is to examine the incidence of Roux limb compression with particular attention to the timing of presentation and associated weight loss in the setting of a university hospital in the United States. Methods: A retrospective chart review was performed of all patients undergoing laparoscopic Roux-en-Y gastric bypass who developed symptomatic small bowel obstruction requiring operative intervention from January 1, 2000 and September 15, 2006. Results: Of 2215 patients, 20 (.9%) developed symptomatic Roux limb compression. The mean time to presentation was 48 days after LRYGB. By this stage, the mean percentage of excess body weight loss was 29%. Of the 20 patients, 19 underwent an upper gastrointestinal contrast study, the results of which confirmed the diagnosis. In all cases, laparoscopic intervention was successful in freeing the constricted Roux limb by dividing the cicatrix formation between the Roux limb and mesocolic window. Switching from continuous to interrupted closure of the space between Roux limb and mesocolic window appeared to reduce the incidence of this complication (P .05). Conclusion: Narrowing at the transverse mesocolon rent is an uncommon cause of small bowel obstruction after retrocolic laparoscopic Roux-en-Y gastric bypass. Unlike internal hernias, which tend to occur later in the clinical course and are associated with significant weight loss, Roux limb obstruction occurs earlier after gastric bypass and is not associated with significant weight loss. Interrupted closure of the mesocolic window might reduce the risk of Roux compression. (Surg Obes Relat Dis 2009;5: 194 –198.) © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. Keywords: Small bowel obstruction; Gastric bypass; Roux limb obstruction Obesity is being increasingly recognized as a major threat to human health in the developed world, with 120 million people worldwide classified as clinically obese. In- creased weight causes increased morbidity and mortality because of its association with cardiovascular disease, dia- betes, and certain cancers. Gastric bypass surgery is cur- Supported by grant 1-UL1-RR024160-01 from the National Center for Research Resources, National Institutes of Health and the National Insti- tutes of Health Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the National Institutes of Health. Information on the National Center for Research Resources is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clini- calresearch/overview-translational.asp. *Reprint requests: Ahmed R. Ahmed, M.D., F.R.C.S. (Gen.Surg.), Department of Bariatric Surgery, University of Rochester Medical Center, Highland Hospital, 1000 South Avenue, Rochester, NY 14620. E-mail: ahmed_ahmed@urmc.rochester.edu Surgery for Obesity and Related Diseases 5 (2009) 194 –198 1550-7289/09/$ – see front matter © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2008.02.004