Candy cane syndrome with or without concomitant hiatal hernia after Roux-en-Y gastric bypass: A hidden enemy leading to postoperative symptoms

Italo Braghetto; Owen Korn; Ramon Sanz-Ongil; Ana Burgos; Deycies Gaete

doi:10.1016/j.cireng.2024.11.004

Candy cane syndrome with or without concomitant hiatal hernia after Roux-en-Y gastric bypass: A hidden enemy leading to postoperative symptoms

Cir Esp (Engl Ed). 2024 Nov 18:S2173-5077(24)00260-6. doi: 10.1016/j.cireng.2024.11.004. Online ahead of print.

Authors

Italo Braghetto¹, Owen Korn², Ramon Sanz-Ongil³, Ana Burgos², Deycies Gaete²

Affiliations

¹ Department of Surgery, Hospital Jose J. Aguirre, Faculty of Medicine, University of Chile. Electronic address: ibraghet@hcuch.cl.
² Department of Surgery, Hospital Jose J. Aguirre, Faculty of Medicine, University of Chile.
³ Department of Surgery Hospital Universitario de la Princesa, Madrid, Spain.

PMID: 39566575
DOI: 10.1016/j.cireng.2024.11.004

Abstract

Background: Candy cane syndrome (CCS) is a rare complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). It occurs due to redundancy in the blind loop at the gastro-jejunal anastomosis.

Objective: To evaluate the type of symptoms, anatomic and functional findings, and outcome after treatment.

Material and methods: A prospective case series study was conducted between 2010 and 2022, including symptomatic patients with CCS after LRYGB. Symptoms were correlated with anatomic and functional findings. Big gastric pouch was defined if its size was >5 cm, and a long candy cane loop was diagnosed if its length was >5 cm. Due to failure of medical treatment, revision surgery (RS) was indicated for resection of the elongated blind jejunal loop, resizing the redundant gastric pouch and repairing the hiatal hernia repair (HH) when necessary.

Results: The study included 23 patients, with a mean age of 49 ± 11 years. Twenty-one patients underwent primary LRYGB, and 2 were converted to this technique after sleeve gastrectomy (SG). The mean time from LRYGB to symptom onset was 7.6 ± 4.3 years. Pain and reflux symptoms were the most frequent, with no differences between patients with or without HH (P < .05). CCS coexisted with a large gastric pouch in 56.5% and HH in 52.2% of cases. A defective lower esophageal sphincter, abnormal esophageal motility, and pathological acid reflux test were observed. After surgery, improvement was observed in 86.9%.

Conclusion: CCS can lead to gastrointestinal symptoms following LRYGB, regardless of the presence of HH. Complete examinations are crucial for diagnosis and to determine the surgical intervention, which is the best option for treatment.

Keywords: Anastomosis en Y de Roux; Bypass gástrico; Candy cane syndrome; Gastric bypass; Hernia de hiato; Hiatal hernia; Procedimiento quirúrgico; Roux-en-Y anastomosis; Surgical procedure; Síndrome del bastón de caramelo.