Background

Candy cane syndrome is one of the underappreciated reasons for abdominal pain after gastric bypass surgery.

Methods

A retrospective analysis of all candy cane resections performed at Harlem Hospital Center between January 2019 and December 2020 were included. All patients had EGD performed to rule out ulcer disease or other causes of pain as part of pre-operative work up. Patients' characteristics including age, gender, BMI, length of symptoms, and presence of hiatal hernia were analyzed.

Results

A total of twenty-five patients underwent candy cane resection during the study time period. The median age of patients was 46 years. The main symptoms were abdominal pain, followed by nausea and vomiting, GERD, and weight regain. The average length of the candy cane was 11 cm. Twelve patients out of twenty-five had only isolated candy cane on diagnostic laparoscopy. Four patients had dilated gastric pouch along with candy cane; the gastric pouch was partially resected. Four patients had hiatal hernia repair along with candy cane resection. Three patients had candy cane and mesenteric hernia defect. One patient had an incisional hernia, one patient had incarcerated trocar site hernia. Four patients out of twenty-five (16%) reported persistent abdominal pain on approximately 6 months follow up.

Conclusions

Diagnostic laparoscopy and candy cane resection will improve the symptoms of 84% of the patients if all other pathology found on laparoscopy was treated. Effort should be made to resect excess roux limb in the index surgery.