Cirugía y Cirujanos

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirugía y Cirujanos >Year 2010, Issue 4

Romero-Mejía C, Camacho-Aguilera JF, Paipilla-Monroy O
“Candy cane” Roux syndrome in laparoscopic gastric bypass
Cir Cir 2010; 78 (4)

Language: Español
References: 24
Page: 347-351
PDF: 372.76 Kb.

Full text


Background: With the worldwide epidemic of obesity, there has been an increase in the numbers of procedures of bariatric surgery such as the Roux-en-Y gastric bypass. Nevertheless, this type of surgery is not exempt from complications such asthose described as “candy cane” Roux syndrome.
Clinical case: We present the case of a 34-year-old female with previous diagnosis of morbid obesity (BMI 38.5 kg/m2) who underwent laparoscopic Roux-en-Y gastric bypass 2 years previously. Six months ago the patient presented intermittent epigastric pain of moderate intensity radiating towards the left hypochondrium. The patient reported no limitations of activities of daily living. Pain was associated with ingestion of carbonated beverages and ventral decubitus position. Upper gastrointestinal (GI) series was done, observing a blind, dilated jejunal loop adjacent to the gastrojejunal anastomosis. Suspicion of “candy cane” Roux syndrome was established. Exploratory laparoscopy and resection of the blind jejunal loop with stapler was done. Nine months later the patient is asymptomatic.
Conclusions: Symptoms of these patients are nonspecific, and a high level of suspicion is required. The best study to evaluate this clinical entity is the upper GI series. The recommendation for bariatric surgeons is to minimize the length of the blind loop in the gastrojejunal anastomosis and to place ittowards the right side to favor its drainage by gravity and eliminate problems in the jejuno-jejuno anastomosis that cause a retrograde expansion of the Roux-en-Y limb. Therefore, laparoscopic resection is the best method for the treatment of this syndrome.

Key words: Gastric bypass, morbid obesity, “candy cane” roux syndrome.


  1. Ogden Cl, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002;288:1728-1732.

  2. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004;291:2847-2850.

  3. Salinsky E, Scott W. Obesity in America: A Growing Threat. Washington: The George Washington University; 2003. pp. 1-31.

  4. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 2000. pp. 24-27.

  5. Heitmann BL. Ten-year trends in overweight and obesity among Danish men and women aged 30–60 years. Int J Obes Relat Metab Disord 2000;24:1347-1352.

  6. Moreno EB, Zugasti MA. Cirugía bariátrica: situación actual. Rev Med Univ Navarra 2004;48:66-71.

  7. Mason EE, Printen KJ, Blommers TJ, Lewis JW, Scott DH. Gastric bypass in morbid obesity. Am J Clin Nutr 1980;33:395-405.

  8. Cummings DE, Overduin J, Foster SKE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab 2004;89:2608-2615.

  9. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724-1737.

  10. Glenny AM, O’Meara S, Melville A, Sheldon TA, Wilson C. The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 1997;21:715-737.

  11. Davis MM, Slish K, Chao C, Cabana MD. National trends in bariatric surgery, 1996-2002. Arch Surg 2006;141:71-75.

  12. Smoot TM, Xu P, Hilsenrath P, Kuppersmith NC, Singh KP. Gastric bypass surgery in the United States, 1998-2002. Am J Public Health 2006;96:1187-1189.

  13. Merkle EM, Hallowell PT, Crouse C, Nakamoto DA, Stellato TA. Rouxen- Y gastric bypass for clinically severe obesity: normal appearance and spectrum of complications at imaging. Radiology 2005;234:674- 683.

  14. Podnos YD, Jiménez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass. A review of 3464 cases. Arch Surg 2003;138:957-961.

  15. Marshall JS, Srivastava A, Gupta SK, Rossi TR, DeBord JR. Roux-en- Y bypass leak complications. Arch Surg 2003;138:520-524.

  16. Yu J, Turner MA, Cho SR, Fulcher AS, DeMaria EJ, Kellum JM, et al. Normal anatomy and complications after gastric bypass surgery: helical CT findings. Radiology 2004;231:753-760.

  17. Buchwald H. Overview of bariatric surgery. J Am Coll Surg 2002;194:367-375.

  18. Perugini RA, Mason R, Czerniach DR, Novitsky YW, Baker S, Litwin DEM, et al. Predictors of complications and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass. Arch Surg 2003;138:541- 546.

  19. Dallal RM, Cottam D. “Candy cane” Roux syndrome–a possible complication after gastric bypass surgery. Surg Obes Relat Dis 2007;3:408- 410.

  20. Watemberg S, Landau O, Avrahami R. Zenker’s diverticulum: reappraisal. Am J Gastroenterol 1996;91:1494-1498.

  21. Ferreira LEVVC, Simmons DT, Baron TH. Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 2008;21:1-8.

  22. Koehler RE, Halverson JD. Radiographic abnormalities after gastric bypass. Am J Roentgenol 1982;138:267-270.

  23. Blanchar A, Federle MP, Pealer KM, Ikramuddin S, Schauer PR. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology 2002;223:625-632.

  24. Quebbermann BB, Dallal RM. The orientation of the antecolic Roux limb markedly affects the incidence of internal hernias after laparoscopic gastric bypass. Obes Surg 2005;15:766-770.

>Journals >Cirugía y Cirujanos >Year 2010, Issue 4

· Journal Index 
· Links 

Copyright 2019