Imperial College London


Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Professor of Practice (Metabolic Medicine & Endocrinology)



+44 (0)20 3313 8038t.tan




6N6ECommonwealth BuildingHammersmith Campus






BibTex format

author = {Kamocka, A and McGlone, ER and Pérez-Pevida, B and Moorthy, K and Hakky, S and Tsironis, C and Chahal, H and Miras, AD and Tan, T and Purkayastha, S and Ahmed, AR},
doi = {10.1007/s00464-019-06988-4},
journal = {Surgical Endoscopy},
pages = {2076--2081},
title = {Candy cane revision after Roux-en-Y gastric bypass},
url = {},
volume = {34},
year = {2020}

RIS format (EndNote, RefMan)

AB - BACKGROUND: An excessively long-blind end of the alimentary limb following a Roux-en-Y gastric bypass (RYGB), known as a 'candy cane' (CC), may cause symptoms including abdominal pain, regurgitation and vomiting. Very few studies have examined the efficacy of surgical resection of the CC. OBJECTIVES: The aim of this study was to assess sensitivity of preoperative diagnostic tools for CC, as well as perioperative outcomes and symptom resolution after CC revision surgery. SETTING: High volume bariatric centre of excellence, United Kingdom. METHODS: Observational study of CC revisions from 2010 to 2017. RESULTS: Twenty-eight CC revision cases were identified (mean age 45 ± 9 years, female preponderance 9:1). Presenting symptoms were abdominal pain (86%), regurgitation/vomiting (43%), suboptimal weight loss (36%) and acid reflux (21%). Preoperative tests provided correct diagnosis in 63% of barium contrast swallows, 50% of upper gastrointestinal endoscopies and 29% computed tomographies. Patients presenting with pain had significantly higher CC size as compared with pain-free group (4.2 vs. 2 cm, p = 0.001). Perioperative complications occurred in 25% of cases. Complete or partial symptom resolution was documented in 73% of patients undergoing CC revision. Highest success rates were recorded in the regurgitation/vomiting group (67%). CONCLUSION: Surgical revision of CC is associated with good symptom resolution in the majority of patients, especially those presenting with regurgitation/vomiting. However, it carries certain risk of complications. CC diagnosis may frequently be missed; hence more than one diagnostic tool should be considered when investigating symptomatic patients after RYGB.
AU - Kamocka,A
AU - McGlone,ER
AU - Pérez-Pevida,B
AU - Moorthy,K
AU - Hakky,S
AU - Tsironis,C
AU - Chahal,H
AU - Miras,AD
AU - Tan,T
AU - Purkayastha,S
AU - Ahmed,AR
DO - 10.1007/s00464-019-06988-4
EP - 2081
PY - 2020///
SN - 0930-2794
SP - 2076
TI - Candy cane revision after Roux-en-Y gastric bypass
T2 - Surgical Endoscopy
UR -
UR -
UR -
VL - 34
ER -