Background

Early postoperative small bowel obstruction (ESBO) following roux-en-Y gastric bypass (RYGB) is a feared complication, generally estimated to occur in 1-2% of cases. Most surgeons advocate for prompt surgical exploration for ESBO after RYGB. There is currently a paucity of literature regarding conservative management approaches to ESBO after RYGB. The objective of this study is to determine the feasibility of nonoperative management for ESBO after RYGB.

Methods

We performed a retrospective review of all patients at a single institution who underwent RYGB between July 1, 2020 and November 1, 2023 and were readmitted within 30 days of the procedure due to a small bowel obstruction.

Results

2084 RYGBs were performed, 56 unique patients (2.7%) experienced ESBO. Patients were 93% female, with a mean age 47.4 years, mean BMI 38.8, and mean ASA score 2.4. Mesenteric defects were closed with permanent suture in 100% of cases. The average interval from time of surgery to diagnosis of ESBO was 9.4 days. 46 patients (82.1%) were successfully managed conservatively, with 19 (40.4%) of those patients receiving nasogastric tube decompression. 10 patients (17.9%) required surgery either due to failed conservative management or concerning radiographic features prompting immediate return to the operating room. 1 patient (1.8%) underwent jejunojejunostomy revision.

Conclusions

This study demonstrates that conservative management may be a safe and effective treatment option for early bowel obstruction following roux-en-Y gastric bypass.