Gastric Bypass pp 235-245 | Cite as

Abdominal Pain After Gastric Bypass

  • Alexander Charles Morrell
  • André Luiz Gioia Morrell
  • Alexander Charles MorrellJr.
  • Allan Gioia Morrell


Obesity remains a worldwide disease, often with social, physical and psychological involvement that results in worsening of quality of life and increased risk to health. Among its possibilities of surgical treatment, gastric bypass is still a procedure of greater choice for most patients, being well established both by conventional and laparoscopic approach in the major centers of bariatric surgery. As with all surgical procedures, this surgery allows complications of early and late stroke, most of them presenting with abdominal pain or discomfort, which should be evaluated in order to better understand and treatment.


  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723.PubMedCrossRefGoogle Scholar
  2. 2.
    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804.CrossRefGoogle Scholar
  4. 4.
  5. 5.
    Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine. 2006;29:109–17.PubMedCrossRefGoogle Scholar
  6. 6.
    Karlsen TI, Lund RS, Roislien J, Tonstad S, Natvig GK, Sandbu R, Hjelmesaeth J. Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study. Health Qual Life Outcomes. 2013;11:17.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Sears D, Fillmore G, Bui M, Rodriguez J. Evaluation of gastric bypass patients 1 year after surgery: changes in quality of life and obesity-related conditions. Obes Surg. 2008;18:1522–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.CrossRefGoogle Scholar
  9. 9.
    Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223–31.CrossRefGoogle Scholar
  10. 10.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22(12):2554–63. Epub 2008 Sep 20.PubMedCrossRefGoogle Scholar
  12. 12.
    Macht R, George J, Ameli O, Hess D, Cabral H, Kazis L. Factors associated with bariatric postoperative emergency department visits. Surg Obes Relat Dis. 2016. pii: S1550-7289(16)00084-8.[Epub ahead of print].
  13. 13.
    Alsulaimy M, Dorsey A, Sethi S, Schauer PR, Aminian A. Encapsulated omental necrosis after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(4):919–20. Epub 2016 Feb 18.PubMedCrossRefGoogle Scholar
  14. 14.
    Frederiksen SG, Ekelund M. Mesenteric torsion as a cause of late abdominal pain after gastric bypass surgery. Obes Surg. 2016;26(4):896–9. Scholar
  15. 15.
    Sima E, Hedberg J, Sundbom M. Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis. Surg Endosc. 2016;30(4):1553–8. Epub 2015 Jul 11.CrossRefPubMedGoogle Scholar
  16. 16.
    Shimizu H, Maia M, Kroh M, Schauer PR, Brethauer SA. Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):718–24. Epub 2012 Jun 21CrossRefPubMedGoogle Scholar
  17. 17.
    Noh KW, Wolfsen HC, Bridges MD, Hinder RA. Mesenteric vein thrombosis after laparoscopic anti reflux surgery. Dig Dis Sci. 2007;52(1):273–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Salinas J, Barros D, Salgado N, Viscido G, Funke R, Pérez G, Pimentel F, Boza C. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Surg Endosc. 2014;28:1083–9.PubMedCrossRefGoogle Scholar
  19. 19.
    James AW, Rabl C, Westphalen AC, Fogarty PF, Posselt AM, Campos GM. Portomesenteric venous thrombosis after laparoscopic surgery: a systematic literature review. Arch Surg. 2009;144(6):520–6. Scholar
  20. 20.
    El Lakis MA, Pozzi A, Chamieh J, Safadi B. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass: a 36-case series. Surg Endosc. 2016.[Epub ahead of print].Google Scholar
  21. 21.
    Smith MD, Adeniji A, Wahed AS, Patterson E, Chapman W, Courcoulas AP, Dakin G, Flum D, McCloskey C, Mitchell JE, Pomp A, Staten M, Wolfe B. Technical factors associated with anastomotic leak after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(2):313–20. Epub 2014 Nov 8.CrossRefGoogle Scholar
  22. 22.
    Fernandez AZ Jr, EJ DM, Tichansky DS, Kellum JM, Wolfe LG, Meador J, Sugerman HJ. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7. Epub 2003 Dec 29.PubMedCrossRefGoogle Scholar
  23. 23.
    Melinek J, Livingston E, Cortina G, Fishbein MC. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med. 2002;126(9):1091–5.PubMedGoogle Scholar
  24. 24.
    Sima E, Hedberg J, Ehrenborg A, Sundbom M. Differences in early complications between circular and linear stapled gastrojejunostomy in laparoscopic gastric bypass. Obes Surg. 2014;24(4):599–603. Scholar
  25. 25.
    Hamilton EC, Sims TL, Hamilton TT, Mullican MA, Jones DB, Provost DA. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17(5):679–84. Epub 2003 Mar 7.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S, Rosenthal R, Murr MM. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55. Epub 2006 Nov 17.PubMedCrossRefGoogle Scholar
  27. 27.
    Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(6):623–30. Epub 2008 Apr 8.CrossRefPubMedGoogle Scholar
  28. 28.
    Csendes A, Burdiles P, Burgos AM, Maluenda F, Diaz JC. Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg. 2005;15(9):1252–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Monkhouse SJ, Morgan JD, Norton SA. Complications of bariatric surgery: presentation and emergency management--a review. Ann R Coll Surg Engl. 2009;91(4):280–6. Epub 2009 Apr 2.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Coblijn UK, de Raaff CA, van Wagensveld BA, van Tets WF, de Castro SM. Trocar port hernias after bariatric surgery. Obes Surg. 2016;26(3):546–51. Scholar
  31. 31.
    Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia. 2011;15(2):113–21. Epub 2010 Dec 9.CrossRefPubMedGoogle Scholar
  32. 32.
    Losanoff JE, Richman BW, Jones JW. Trocar-site hernia complicated by necrotizing fasciitis--case report and review of the literature. Hernia. 2003;7(4):220–3. Epub 2003 Apr 10.PubMedCrossRefGoogle Scholar
  33. 33.
    Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004;139(11):1248–56.PubMedCrossRefGoogle Scholar
  34. 34.
    Papasavas PK, Yeaney WW, Caushaj PF, Keenan RJ, Landreneau RJ, Gagné DJ. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(5):797–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Hainaux B, Agneessens E, Bertinotti R, De Maertelaer V, Rubesova E, Capelluto E, Moschopoulos C. Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol. 2006;187(5):1179–83.PubMedCrossRefGoogle Scholar
  36. 36.
    Gagner M, Gentileschi P, de Csepel J, Kini S, Patterson E, Inabnet WB, Herron D, Pomp A. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.PubMedCrossRefGoogle Scholar
  37. 37.
    Kumbhari V, Tieu AH, Ngamruengphong S, Aguila G, Schweitzer MA, Khashab MA, Singh VK. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Gastrointest Endosc. 2015;82(4):747. Epub 2015 Jun 25.CrossRefPubMedGoogle Scholar
  38. 38.
    Espinel J, Pinedo E. Stenosis in gastric bypass: endoscopic management. World J Gastrointest Endosc. 2012;4(7):290–5. Scholar
  39. 39.
    de-la-Cruz-Vigo F, de-la-Cruz-Vigo JL. Stenosis in gastric bypass for morbid obesity. [aArticle in English, Spanish]. Rev Esp Enferm Dig. 2010;102(3):151–8.Google Scholar
  40. 40.
    Wetter A. Role of endoscopy after Roux-en-Y gastric bypass surgery. Gastrointest Endosc. 2007;66(2):253–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Lee JK, Van Dam J, Morton JM, Curet M, Banerjee S. Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery. Am J Gastroenterol. 2009;104(3):575–82; quiz 583. Epub 2009 Feb 3. Scholar
  42. 42.
    Rosenthal RJ. Dilating the stenotic gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass for morbid obesity: when things go wrong. J Gastrointest Surg. 2009;13(9):1561–3. Epub 2009 Mar 19.CrossRefPubMedGoogle Scholar
  43. 43.
    Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132(6):2253–71.CrossRefGoogle Scholar
  44. 44.
    Sverdén E, Mattsson F, Sondén A, Leinsköld T, Tao W, Lu Y, Lagergren J. Risk factors for marginal ulcer after gastric bypass surgery for obesity: a population-based cohort study. Ann Surg. 2016;263(4):733–7. Scholar
  45. 45.
    Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8(5):505–16.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Chau E, Youn H, Ren-Fielding CJ, Fielding GA, Schwack BF, Kurian MS. Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(5):1071–5. Epub 2014 Dec 19.CrossRefPubMedGoogle Scholar
  47. 47.
    Jordan JH, Hocking MP, Rout WR, Woodward ER. Marginal ulcer following gastric bypass for morbid obesity. Am Surg. 1991;57(5):286–8.PubMedGoogle Scholar
  48. 48.
    Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2(4):460–3.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Sanyal AJ, Sugerman HJ, Kellum JM, Engle KM, Wolfe L. Stomal complications of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol. 1992;87(9):1165–9.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Friedman GD, Kannel WB, Dawber TR. The epidemiology of gallbladder disease: observations in the Framingham Study. J Chronic Dis. 1966;19(3):273–92.PubMedCrossRefGoogle Scholar
  51. 51.
    Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989;149(8):1750–3.PubMedCrossRefGoogle Scholar
  52. 52.
    Shiffman ML, Sugerman HJ, Kellum JM, Brewer WH, Moore EW. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86(8):1000–5.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Sugerman HJ, Brewer WH, Shiffman ML, Brolin RE, Fobi MA, Linner JH, MacDonald KG, MacGregor AM, Martin LF, Oram-Smith JC, et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995;169(1):91–6; discussion 96–7.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med. 1994;154(22):2573–81.PubMedCrossRefGoogle Scholar
  55. 55.
    Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56(2):225–32.PubMedCrossRefGoogle Scholar
  56. 56.
    Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89. discussion 289-91.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients--what have we learned? Obes Surg. 2000;10(6):509–13.CrossRefGoogle Scholar
  58. 58.
    Steele KE, Prokopowicz GP, Magnuson T, Lidor A, Schweitzer M. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc. 2008;22(9):2056–61. Epub 2008 Feb 13.CrossRefGoogle Scholar
  59. 59.
    Gunabushanam G, Shankar S, Czerniach DR, Kelly JJ, Perugini RA. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass surgery. J Comput Assist Tomogr. 2009;33(3):369–75. Scholar
  60. 60.
    Husain S, Ahmed AR, Johnson J, Boss T, O'Malley W. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg. 2007;142(10):988–93.CrossRefGoogle Scholar
  61. 61.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Al Harakeh AB, Kallies KJ, Borgert AJ, Kothari SN. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2016;12(1):194–8. Epub 2015 Feb 11CrossRefPubMedGoogle Scholar
  63. 63.
    Al-Saeed O, Fahmy D, Kombar O, Hasan A. Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery. Med Princ Pract. 2013;22:540–4. Epub 2013 Aug 8.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Iannelli A, Buratti MS, Novellas S, Dahman M, Amor IB, Sejor E, Facchiano E, Addeo P, Gugenheim J. Internal hernia as a complication of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(10):1283–6.PubMedCrossRefGoogle Scholar
  65. 65.
    Al-Mansour MR, Mundy R, Canoy JM, Dulaimy K, Kuhn JN, Romanelli J. Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass. Obes Surg. 2015;25(11):2106–11. Scholar
  66. 66.
    Stephenson D, Moon RC, Teixeira AF, Jawad MA. Intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10(4):666–70. Epub 2014 Jan 30CrossRefPubMedGoogle Scholar
  67. 67.
    Sujka J, Teixeira AF, Jawad MA. Suspected cecal volvulus as a reason for abdominal pain after gastric bypass: a case series. Surg Obes Relat Dis. 2015;11(4):978–9. Epub 2015 Apr 23.CrossRefPubMedGoogle Scholar
  68. 68.
    Cawley J, Sweeney MJ, Kurian M, Beane S. New York State Bariatric Surgery Workgroup. Predicting complications after bariatric surgery using obesity-related co-morbidities. Obes Surg. 2007;17(11):1451–6.PubMedCrossRefGoogle Scholar
  69. 69.
    Lee CJ, Clark JM, Schweitzer M, Magnuson T, Steele K, Koerner O, Brown TT. Prevalence of and risk factors for hypoglycemic symptoms after gastric bypass and sleeve gastrectomy. Obesity (Silver Spring). 2015;23(5):1079–84. Epub 2015 Apr 10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Alexander Charles Morrell
    • 1
  • André Luiz Gioia Morrell
    • 2
  • Alexander Charles MorrellJr.
    • 2
  • Allan Gioia Morrell
    • 2
  1. 1.General Surgery/Bariatric and Metabolic Surgery/Robotic SurgerySociedade Beneficente Israelita Brasileira Hospital Albert EinsteinSão PauloBrazil
  2. 2.General Surgery/Bariatric and Metabolic SurgerySociedade Beneficente Israelita Brasileira Hospital Albert EinsteinSão PauloBrazil

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