Laparoscopic and endoscopic treatment of a complicated candy cane syndrome after Roux-en-Y gastric bypass
Epublication WebSurg.com, Feb 2014;14(02). URL: http://websurg.com/doi/vd01en4162
A “Candy Cane” Roux syndrome represents an excessive length of non-functional Roux limb proximal to the gastrojejunostomy, which can cause abnormal upper gastrointestinal symptoms of postprandial epigastric discomfort that is relieved by vomiting. Symptoms of reflux, loss of satiety, and nausea are also common. The length of the blind loop is the essential factor to explain these symptoms, but the orientation of the gastrojejunal anastomosis is equally important to facilitate the emptying of the gastric pouch. Scarce data can be found in the literature --a case report (1) and a case series (2) with a number of limitations. It is not possible to determine a critical excess length of Roux limb at which symptoms would become evident, nor were we able to determine whether all patients, or just a small minority, would develop symptoms, even with a seemingly excessive Roux limb. Patients who underwent a gastric bypass technique with a gastrojejunal anastomosis using a circular stapler seem to be more likely to develop this anomaly. All 3 patients described by Cottam et al. (2) have their primary procedure performed by means of a circular stapler. A long, non-functional Roux limb tip may cause persistent nausea, postprandial epigastric pain, and even a lack of satiety. Surgeons should attempt to minimize redundancy in the Roux limb during the primary procedure. Limiting the length and orientating the Roux limb to aid in gravity and drainage during the initial operation may prevent this syndrome. References: 1. Dallal RM, Cottam D. "Candy cane" Roux syndrome--a possible complication after gastric bypass surgery. Surg Obes Relat Dis 2007;3:408-10. 2. Romero-Mejía C, Camacho-Aguilera JF, Paipilla-Monroy O. "Candy cane" Roux syndrome in laparoscopic gastric by-pass. Cir Cir 2010;78:347-51.