Background

Candy cane syndrome is a complication that occurs following Roux-en-Y gastric bypass, implicated as a long blind limb at gastrojejunostomy possibly caused by the use of circular staplers. It may manifest with a wide variety of underappreciated gastrointestinal symptoms.

Methods

We performed a retrospective analysis of patients who underwent CC resection at our institution from 2017 to 2023. The patient's charts were then reviewed to evaluate for symptoms, operative and weight data. Only patients with an afferent blind limb in the most direct outlet from the GJ visualized on upper GI study and endoscopy were included.

Results

29 patients had resection of the CC (83% female; 50.3+12.9 years) within 11+6 years after initial RYGB. 58.6% underwent a concomitant procedure (10 HHR, 4 redo-GJ, and 3 internal hernia reduction and defect closure). The mean length of the CC was 7.5+3.9 cm. Resection of CC was performed in 62.1% stapling only, 34.5% stapling and oversewing, and 3.4% oversewing only. Mean length of stay was 3.4+2.5 days. 30-day hospital readmission rate was 7.4% (n=2). At 8.5-month follow-up, there was a significant reduction (p<.005) of bloating, nausea/vomiting, and dysphagia, however, abdominal pain and diarrhea slightly decreased. EWL% was 29.4+5.6% and BMI decreased from 32.1+-7.3 to 29.1+-4.7 Kg/m2.

Conclusions

The resection of the blind afferent limb can be managed safely with excellent outcomes and resolution of symptoms, even if major procedures are performed concomitantly. Surgeons should resect the excess roux limb in the initial RYGB to decrease the likelihood of this syndrome.