The authors have experienced 9 cases of postgastrectomy efferent loop obstruction during the past 16 months' period and analyzed the clinical features, radiological findings causes, and types of obstruction. The incidence of efferent loop
obstruction
was 1.3%/(9/673). Among the 9 cases, eight patients were male and one patient was female. Median age was 60 years and more than half(5 out of 9 cases) of the patients were obese(defined by more than 110% of ideal body weight). None of the cases
showed
signs of strangulation, including persistent pain, fever, focal abdominal tenderness, and/or leukocytosis. Gastrointestinal anastomosis were done using a GIA stapler in 6 cases, and manually in 3 cases. The diagnoses were made on the basis of
clinical
symptoms and signs, further supported by radiologic contrast studies. All the patients were initially treated with conservative measures, including nasogastric drainage and fluid therapy for about 2 weeks in average. 7 cases underwent
re-laparoctomy
using separate left subcostal incisions as conservative management had faired. Among the relaparotomy cases, adhesiolysis and side to side jejunojejunostomy were performed in 5 patients, roux-ex-Y gastrojejunostomy in 1 patient, and
gastrojejunostomy
revision in 1 patient. Causes of the obstruction in the seven re-o-pened cases were confirmed as postoperative adhesion. The authors have analyzed the pattern of obstruction and classified the patterns into 4 types. One of the remaining two
patients
underwent balloon dilatation successfully and the other was managed with prolonged nasogastric decompression. The average hospital stay was 32 days. Adequate omentectomy, gentle tissue handling during dissection, avoidance of ischemia along the
suture
line of anastomosis, and the use of biologically inert suture material would prevent this kind of postoperative adhesive obstruction.
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