“Candy Cane Syndrome”: an Underappreciated Cause of Abdominal Pain and Nausea After Roux-en-Y Gastric Bypass Surgery

Abstract Background “Candy Cane syndrome” (a blind afferent Roux limb at the gastro-jejunostomy) has been implicated as a cause of abdominal pain, nausea, and emesis after Roux-n-Y gastric bypass procedure (RYGBP), but remains poorly described. Objectives To demonstrates that “candy cane” syndrome is real and can be treated effectively with revisional bariatric surgery. Setting All patients underwent candy cane resection at University Hospitals of Cleveland. Methods All patients who underwent resection of the “candy cane” between January, 2011, and July, 2015 were included. All had pre-operative work up to identify “Candy Cane Syndrome”. Demographic data, pre-, peri- and post-operative symptoms, data regarding the hospitalization and post-operative weight loss were assessed through retrospective chart review. Data was analyzed using student’s T-test and chi square analysis where appropriate. Results Nineteen patients had resection of the “candy cane” (94% female, mean age 50±11), within 3-11 years after initial RYGB. Primary presenting symptoms were epigastric abdominal pain (68%) and nausea/vomiting (32%), particularly with fibrous foods and meats. On upper gastrointestinal (UGI) study and endoscopy the afferent blind limb was the most direct outlet from the gastro-jejunostomy. Only patients with these preoperative findings were deemed to have ‘candy cane syndrome’. Eighteen (94%) cases were completed laparoscopically. Length of the candy cane ranged from 3-22 cm. Median length of stay was 1 day. After resection, 18 (94%) patients had complete resolution of their symptoms (p