■Roux-en-Y胃旁路术(RYGB)仍然是病态肥胖最常见的手术之一,并且与显着的长期体重减轻和合并症缓解有关。然而,RYGB后的医疗保健利用率很高,据报道,腹痛是寻求治疗者最常见的症状.
■鉴于肥胖患者体检的局限性,RYGB后腹痛的正确诊断取决于仔细的病史和适当的放射学应用,实验室和内窥镜研究,以及对RYGB后解剖结构的清晰理解。RYGB术后最常见的腹痛病因是内疝,边缘溃疡,胆道疾病(例如,胆石症和胆总管结石),和空肠吻合问题。早期识别疼痛的病因至关重要,作为一些原因,如腹内疝或胃空肠溃疡穿孔,可能需要紧急或紧急干预,以避免严重的发病率。虽然实验室发现和成像可能被证明是有用的,他们仍然不完美,应始终使用临床判断来确定是否需要手术探查。
■RYGB后腹痛的病因从相对良性到可能危及生命。本综述强调了了解RYGB的关键解剖和技术方面的重要性,以指导适当的检查,诊断,和治疗。
Roux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care.
Given the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted.
The etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This
Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.