Incidence and Treatment of Intussusception Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-Analysis

Abstract Intussusception is a rare yet potentially life threatening complication following Roux-en-Y gastric bypass (RYGB). Multiple case reports have described this complication, and recently, several retrospective studies have been published describing the surgical treatment of intussusception. The aim of this study was to determine the incidence of intussusception following RYGB and provide insight in outcome of subsequent operative treatment. A systematic search was performed using PubMed and Cochrane databases. Article selection was performed using the PRISMA criteria. Articles describing the incidence of intussusception following RYGB, were included. Only when three or more comparable studies reported on the same outcome, data was pooled. The incidence of intussusception, and outcome of subsequent treatment were analyzed. Furthermore, all published case reports describing intussusception following RYGB were analyzed. A total of 74 studies published between 1991 and 2020 were included, describing 191 patients who underwent RYGB and developed intussusception. Sixty-eight case reports including 84 patients were retrieved, and 6 retrospective studies describing outcome of surgical treatment in 107 patients were used for pooling of data. There was a predominance of females among the included patients (85% - 98%). The pooled incidence of intussusception following RYGB was 0.64%. Resection of the affected segment was performed in 34% of the patients. A pooled recurrence rate of 22% was found during follow-up, and resection and reconstruction of the jejunojejunostomy appears to be associated with the lowest risk of recurrence and acceptable complication rates. In conclusion, the pooled incidence of intussusception following RYGB is 0,64%. Typically, patients are female with significant weight loss following RYGB. Symptoms include abdominal pain, nausea and vomiting. Diagnosis is based on clinical findings and CT scanning, warranting early surgical exploration due to the high risk for ischemia. Resection of the jejunojejunostomy appears to be associated with the lowest recurrence rates and acceptable complication rates.