Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 250–256

Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

Authors

  • Ayman Obeid
    • Department of SurgeryUniversity of Alabama at Birmingham
  • Sandre McNeal
    • Department of SurgeryUniversity of Alabama at Birmingham
  • Matthew Breland
    • Department of SurgeryUniversity of Alabama at Birmingham
  • Richard Stahl
    • Department of SurgeryUniversity of Alabama at Birmingham
  • Ronald H Clements
    • Department of SurgeryVanderbilt University
    • Department of SurgeryUniversity of Alabama at Birmingham
2013 SSAT Plenary Presentation

DOI: 10.1007/s11605-013-2377-0

Cite this article as:
Obeid, A., McNeal, S., Breland, M. et al. J Gastrointest Surg (2014) 18: 250. doi:10.1007/s11605-013-2377-0

Abstract

Background

The goal of this study was to determine the impact of mesenteric defect closure and Roux limb position on the rate of internal hernia after laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

A retrospective review was conducted of all LRYGB patients from 2001 to 2011 who had all internal hernia (IH) defects closed (DC) or all defects not closed (DnC).

Results

Of 914 patients, 663 (72.5 %) had DC vs. 251 (27.5 %) with DnC, and 679 (74.3 %) had an ante-colic vs. 235 (25.7 %) with a retro-colic Roux limb. Forty-six patients (5 %) developed a symptomatic IH. Of these, 25 (3.8 %) were in the DC vs. 21 (8.4 %) in the DnC group (p = 0.005), and 26 (3.8 %) were in the ante-colic vs. 20 (8.5 %) in the retro-colic Roux limb position (p = 0.005). Data from 45 patients were available for further analysis. The most common symptom was chronic postprandial abdominal pain (53.4 %). All patients underwent CT scan consistent with IH in 26 patients (57.5 %), suggestive in 7 (15.6 %), showing small bowel obstruction in 4 (8.9 %), and negative in 8 (17.8 %).

Conclusions

Closure of mesenteric defects and ante-colic Roux limb position result in a significantly lower IH rate. Furthermore, a high index of suspicion must be maintained since symptoms may be nonspecific and imaging may be negative in nearly 20 % of patients.

Keywords

Bariatric surgeryLaparoscopic gastric bypassInternal hernia

Copyright information

© The Society for Surgery of the Alimentary Tract 2013