Internal Hernia as a Complication of Laparoscopic Roux-en-Y Gastric Bypass
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Internal hernia (IH) is a well known complication of Roux-en-Y gastric bypass (RYGBP) which is more frequently encountered when the RYGBP is done laparoscopically.
Patients with IH were identified from a prospective data-base of morbidly obese patients undergoing bariatric surgery at our center.
10 patients with IH were identified out of 625 patients undergoing LRYGBP from 1998 to 2006 (incidence 1.6%). The defects were closed in the last 155 cases with non-absorbable running sutures. There were 8 women and 2 men with mean age 38 years (range 28–54).The mean interval of time elapsed between LRYGBP and clinical presentation of IH was 26.5 months (range 7 days 72 months). Abdominal pain, nausea and vomiting were the most common complaints. White blood cell count was increased to a mean of 64 mg/dl (range 45–155 mg/dl) in 6 patients. CT scan showed signs of intestinal obstruction in all 7 patients with acute presentation. Surgery was done by laparoscopy in 5 cases (2 in the setting of emergency), and by laparotomy in the remaining 5 cases. All IHs were located at the mesenteric defect and were treated with IH reduction in all but one patient who underwent small bowel resection. There was no mortality, and one patient had pneumonia with acute respiratory distress syndrome that resolved favorably.
IH after LRYGBP occurred mainly at the mesenteric defect and in patients with no closure of the defect. The antecolic approach for the Roux-limb, the division of the greater omentum only when too thick, and the systematic closure of the defects with tight non-absorbable running sutures are recommended.
- Marema RT, Perez M, Buffington CK. Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries. Surg Endosc 2005; 19: 525–30. CrossRef
- Hwang RF, Swartz DE, Felix EL. Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 2004; 18: 1631–5.
- Calle EE, Rodriguez C, Walker-Thurmond K et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625–38. CrossRef
- Calle EE, Teras LR, Thun MJ. Obesity and mortality. N Engl J Med 2005; 353: 2197–9. CrossRef
- Nguyen NT, Goldman C, Rosenquist CJ et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001; 234: 279–89. CrossRef
- Papasavas PK, Caushaj PF, McCormick JT et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 2003; 17: 610–4. CrossRef
- Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991; 1: 257–65.
- Schauer PR, Ikramuddin S, Gourash W et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232: 515–29. CrossRef
- DeMaria EJ. Is gastric bypass superior for the surgical treatment of obesity compared with malabsorptive procedures? J Gastrointest Surg 2004; 8: 401–3. CrossRef
- Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg 1995; 169: 361–7. CrossRef
- Sugerman HJ, Kellum JM, Engle KM et al. Gastric bypass for treating severe obesity. Am J Clin Nutr 1992; 55: 560S–566S.
- Lujan JA, Frutos MD, Hernandez Q et al. Experience with the circular stapler for the gastrojejunostomy in laparoscopic gastric bypass (350 cases). Obes Surg 2005; 15: 1096–102. CrossRef
- Lujan JA, Frutos MD, Hernandez Q et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg 2004; 239: 433–7. CrossRef
- Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004; 14: 1157–64. CrossRef
- Filip JE, Mattar SG, Bowers SP et al. Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Am Surg 2002; 68: 640–3.
- Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003; 13: 350–4. CrossRef
- Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003; 13: 596–600. CrossRef
- Garza E Jr, Kuhn J, Arnold D et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg 2004; 188: 796–800. CrossRef
- Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2006; 16: 1–7. CrossRef
- Quebbemann BB, Dallal RM. The orientation of the antecolic Roux limb markedly affects the incidence of internal hernias after laparoscopic gastric bypass. Obes Surg 2005; 15: 766–70. CrossRef
- Nguyen NT, Huerta S, Gelfand D et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2004; 14: 190–6. CrossRef
- Comeau E, Gagner M, Inabnet WB et al. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 2005; 19: 34–9. CrossRef
- Coleman MH, Ziad TA, Pomp A et al. Laparoscopic closure of Petersen mesenteric defect. Obes Surg 2006; 16: 770–2. CrossRef
- Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients what have we learned? Obes Surg 2000; 10: 509–13. CrossRef
- Internal Hernia as a Complication of Laparoscopic Roux-en-Y Gastric Bypass
Volume 17, Issue 10 , pp 1283-1286
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Laproscopic Roux-en-Y gastric bypass
- internal hernia
- small bowel obstruction
- bariatric surgery
- Industry Sectors
- Author Affiliations
- 1. Université de Nice-Sophia-Antipolis, Faculté de Médecine, Nice, F-06107, France
- 2. Centre Hospitalier Universitaire de Nice, Pôle Digestif, Nice, F-06202, France
- 3. Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet, 151 Route Saint-Antoine de Ginestière BP 3079, Nice Cedex 3, France
- 4. Service d’Imagerie Médicale, Nice, France