Background

While the extant literature has considered surgical revisions of gastric bypass (RYGB) as a group, few have reported on the specifics of gastrojejunostomy (GJ) revision after RYGB. The aim of this study is to determine the relative incidence, indications, and workup for GJ revision and specifically for so-called candy cane syndrome (CCS).

Methods

Data was obtained through retrospective review of our institutional MBSAQIP database specifically examining GJ revisions performed from 2014-2021. Presenting symptoms, preoperative imaging, revision strategy, intraoperative findings, and postoperative outcomes were reviewed.

Results

Thirty-four GJ revisions were identified: 11 for short Roux limb/bile reflux, 6 for CCS requiring resection of the blind end of the Roux limb, 6 for ulceration, and the remainder for various indications. All 6 patients with presumed CCS had symptoms of postprandial epigastric pain and regurgitation of undigested food. Symptom improvement occurred in 2 after resection. In contrast to the nonresponders, both patients exhibiting improvement had a dilated blind limb and preferential filling on contrast UGI. The average blind limb length in patients whose symptoms improved was 7 cm, and 5.9 cm for those who did not improve.

Conclusions

There are multiple indications for GJ revision after RYGB, including CCS. Patients presenting with postprandial epigastric pain, regurgitation of undigested food, and who have a dilated blind limb that preferentially fills on contrast UGI appear to benefit from blind limb resection.