Excluded-stomach Perforation after Roux-en-Y and One-anastomosis Gastric Bypass: A Systematic Review with Video-illustrated Case Report

Gastric remnant or duodenal perforation after Roux-en-Y gastric bypass (RYGB) or one-anastomosis gastric bypass (OAGB) is rare and may be missed radiologically. We systematically reviewed PubMed, Scopus, and Web of Science and included 26 reports (34 patients), alongside a video-illustrated late OAGB case. Mean age was 49 years, 73.5% were female, and BMI at presentation was 33.58 kg/m²; 32 events followed RYGB and 2 OAGB, occurring a mean of 118.7 months postoperatively. CT was performed in 79.4% and more often showed free fluid than pneumoperitoneum. Laparoscopy (70.6%) with primary repair with or without omental flap or limited remnant resection achieved source control; no completion gastrectomies or 30-day deaths were reported. Early diagnostic laparoscopy should be considered in septic bypass patients with unexplained free fluid; however, the available evidence is limited to case reports and small case series, so definitive conclusions regarding incidence, comparative risk, or causative mechanisms cannot be drawn.