Evidence map›Paper›PMID 42911387›Full record

ArticleSurgical endoscopy2026

Hemobezoar-related jejunojejunostomy obstruction after minimally invasive Roux-en-Y gastric bypass: a systematic review.

Claudia Theis, Victor Andrade Nunes, Sarah Grace Rice, S Davis Scott, Timothy M Farrell, Maggie Hodges, Samuel Ricardo Torres Landa Fernandez

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Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Claudia TheisDepartment of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. claudia_theis@med.unc.edu.ORCID http://orcid.org/0000-0002-1303-298X
Victor Andrade NunesDepartment of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Sarah Grace RiceDepartment of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
S Davis ScottDepartment of Surgery, Emory University, Atlanta, GA, USA.
Timothy M FarrellDepartment of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Maggie HodgesDepartment of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Samuel Ricardo Torres Landa FernandezDepartment of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHemobezoar-related jejunojejunostomy (JJ) obstruction is a rare early complication after minimally invasive Roux-en-Y gastric bypass (RYGB). Although early small bowel obstruction after RYGB is well described, obstruction caused by hemobezoar formation remains poorly characterized.

methodsThis systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261320591). PubMed/MEDLINE, Embase, and CENTRAL were searched from inception through February 2026. Eligible studies reported adults undergoing primary minimally invasive RYGB with early hemobezoar-related JJ obstruction. Data were extracted on study characteristics, presentation, diagnostic modality, operative strategy, gastric decompression, and outcomes. Given its rarity and lack of comparative cohorts, findings were summarized descriptively.

resultsSix studies met inclusion criteria, including 7669 minimally invasive RYGB procedures and 29 hemobezoar-related JJ obstructions. The crude incidence was 0.38%, with per-study incidence ranging from 0.09% to 1.94%. Presentation was consistently early, most commonly within 72 postoperative hours, frequently included tachycardia, nausea, vomiting, abdominal pain, hematocrit decline, and gastrointestinal bleeding. Computed tomography with intravenous contrast was the predominant diagnostic modality, demonstrating dilation of the excluded stomach and proximal limbs with hyperdense intraluminal content at the JJ. Operative management evolved from laparotomy with JJ revision in earlier reports to laparoscopic clot evacuation with selective revision when anastomotic compromise, leak, ischemia, or ongoing bleeding was identified. Gastric remnant decompression was emphasized to reduce closed-loop distension and intraperitoneal contamination. No deaths were reported among 29 cases, although morbidity included abscess formation, anastomotic or staple-line complications, pancreatitis, respiratory complications, readmission, and repeat reoperation.

conclusionHemobezoar-related JJ obstruction after minimally invasive RYGB is uncommon but important. It typically presents within the first postoperative days with obstructive symptoms and evidence of intraluminal bleeding. Across retrospective studies, favorable outcomes were reported following prompt CT diagnosis, early operative exploration, remnant decompression, and minimally invasive clot evacuation with selective anastomotic revision. Prospective validation of this management approach is needed.

Indexed as

Bariatric surgeryHemobezoarIntraluminal blood clotJejunojejunostomy obstructionPostoperative complicationsRoux-en-Y gastric bypassSmall bowel obstruction

Identifiers

PMID42911387

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.