Candy cane revision after Roux-en-Y gastric bypass

A Kamocka, ER McGlone, B Perez-Pevida, K Moorthy, S Hakky, C Tsironis, H Chahal, AD Miras, T Tan, S Purkayastha, AR Ahmed

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
3 Downloads (Pure)

Abstract

Background
An excessively long-blind end of the alimentary limb following a Roux-en-Y gastric bypass (RYGB), known as a ‘candy cane’ (CC), may cause symptoms including abdominal pain, regurgitation and vomiting. Very few studies have examined the efficacy of surgical resection of the CC.

Objectives
The aim of this study was to assess sensitivity of preoperative diagnostic tools for CC, as well as perioperative outcomes and symptom resolution after CC revision surgery.

Setting
High volume bariatric centre of excellence, United Kingdom.

Methods
Observational study of CC revisions from 2010 to 2017.

Results
Twenty-eight CC revision cases were identified (mean age 45 ± 9 years, female preponderance 9:1). Presenting symptoms were abdominal pain (86%), regurgitation/vomiting (43%), suboptimal weight loss (36%) and acid reflux (21%). Preoperative tests provided correct diagnosis in 63% of barium contrast swallows, 50% of upper gastrointestinal endoscopies and 29% computed tomographies. Patients presenting with pain had significantly higher CC size as compared with pain-free group (4.2 vs. 2 cm, p = 0.001). Perioperative complications occurred in 25% of cases. Complete or partial symptom resolution was documented in 73% of patients undergoing CC revision. Highest success rates were recorded in the regurgitation/vomiting group (67%).

Conclusion
Surgical revision of CC is associated with good symptom resolution in the majority of patients, especially those presenting with regurgitation/vomiting. However, it carries certain risk of complications. CC diagnosis may frequently be missed; hence more than one diagnostic tool should be considered when investigating symptomatic patients after RYGB.
Original languageEnglish
Pages (from-to)2076-2081
Number of pages6
JournalSURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
Volume34
Issue number5
Early online date8 Aug 2019
DOIs
Publication statusPublished (in print/issue) - 1 May 2020

Keywords

  • Candy cane
  • Hockey stick
  • Roux-en-Y gastric bypass complications
  • Revisional surgery

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