Hemobezoar-related jejunojejunostomy obstruction after minimally invasive Roux-en-Y gastric bypass: a systematic review
In brief
Blood-clot obstruction affected 0.38% after minimally invasive gastric bypass
A review found 29 cases among 7,669 minimally invasive gastric bypass procedures; obstruction usually appeared within 72 hours and often involved signs of bleeding. Reports describe CT diagnosis and prompt surgery, with no deaths but several complications; because the evidence comes from small retrospective studies, the best management approach still needs prospective validation.
- Journal
- Surgical endoscopy (Q1)
- Published
- 22 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Claudia Theis, Victor Andrade Nunes, Sarah Grace Rice, S Davis Scott, Timothy M Farrell, Maggie Hodges, et al.
- PMID
- 42911387
- DOI
- 10.1007/s00464-026-13487-w
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 25 October 2026): Systematic review of rare early obstruction after Roux-en-Y gastric bypass
Abstract
BACKGROUND: Hemobezoar-related jejunojejunostomy (JJ) obstruction is a rare early complication after minimally invasive Roux-en-Y gastric bypass (RYGB). Although early small bowel obstruction after RYGB is well described, obstruction caused by hemobezoar formation remains poorly characterized. METHODS: This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261320591). PubMed/MEDLINE, Embase, and CENTRAL were searched from inception through February 2026. Eligible studies reported adults undergoing primary minimally invasive RYGB with early hemobezoar-related JJ obstruction. Data were extracted on study characteristics, presentation, diagnostic modality, operative strategy, gastric decompression, and outcomes. Given its rarity and lack of comparative cohorts, findings were summarized descriptively. RESULTS: Six studies met inclusion criteria, including 7669 minimally invasive RYGB procedures and 29 hemobezoar-related JJ obstructions. The crude incidence was 0.38%, with per-study incidence ranging from 0.09% to 1.94%. Presentation was consistently early, most commonly within 72 postoperative hours, frequently included tachycardia, nausea, vomiting, abdominal pain, hematocrit decline, and gastrointestinal bleeding. Computed tomography with intravenous contrast was the predominant diagnostic modality, demonstrating dilation of the excluded stomach and proximal limbs with hyperdense intraluminal content at the JJ. Operative management evolved from laparotomy with JJ revision in earlier reports to laparoscopic clot evacuation with selective revision when anastomotic compromise, leak, ischemia, or ongoing bleeding was identified. Gastric remnant decompression was emphasized to reduce closed-loop distension and intraperitoneal contamination. No deaths were reported among 29 cases, although morbidity included abscess formation, anastomotic or staple-line complications, pancreatitis, respiratory complications, readmission, and repeat reoperation. CONCLUSION: Hemobezoar-related JJ obstruction after minimally invasive RYGB is uncommon but important. It typically presents within the first postoperative days with obstructive symptoms and evidence of intraluminal bleeding. Across retrospective studies, favorable outcomes were reported following prompt CT diagnosis, early operative exploration, remnant decompression, and minimally invasive clot evacuation with selective anastomotic revision. Prospective validation of this management approach is needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.