ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2018) 53 CD2.3 | DOI: 10.1530/endoabs.53.CD2.3

Surgical revision of candy cane after Roux-en-Y gastric bypass (RYGB)

Anna Kamocka, Emma Rose McGlone, Belen Perez Pevida, Sanjay Purkayastha, Krishna Moorthy, Sherif Hakky, Harvinder Chahal, Christos Tsironis, Alexander Miras, Tricia Tan & Ahmed Ahmed

Imperial College, London, UK.

Introduction: An excessively long blind-end of the alimentary limb following RYGB, known as a ‘candy cane’ (CC), may cause symptoms such as pain, gastrointestinal symptoms and weight regain. Very few studies have examined the efficacy of surgical resection of the CC. We aimed to assess symptom resolution following CC surgery.

Methods: Single centre observational study of 28 CC revisions from 2010 to 2017 (mean age 45±8, female preponderance 9:1). Mean time between RYGB and revision was 40±27 months with post-revision follow-up time of 21±15 months. Patients who underwent any other major operative intervention at the same time as CC revision were excluded. Perioperative and follow-up data were analysed. Statistical analysis was performed using SPSS v.20.

Results: Symptoms leading to revision were pain (82%), weight regain (43%), regurgitation/vomiting (40%), acid reflux (18%). Barium swallow and OGD performed in 24 cases revealed a false negative rate of 33% (8/24) and 50% (12/24) respectively. Patients with pain had significantly higher CC size as compared with pain-free group (4 vs 2 cm; P=0.037). There was no correlation between CC size and weight regain or gastrointestinal symptoms. Complete symptom resolution was documented in 27%, partial in 35%, no improvement in 38%. Complications were recorded in 25% (Clavien-Dindo classification: 11% Grade 1, 14% Grade 3b). Median length of stay was 0 days (0–5).

Conclusion: CC surgery results in symptom resolution or improvement in two thirds of cases but as with all revisional surgery, carries a risk of complications. Its diagnosis may frequently be missed; hence more than one diagnostic tool should be considered when investigating symptomatic patients after RYGB.