Skip to main content
SpringerLink
Log in

Internal Hernias: Prevention, Diagnosis, and Management

  • Chapter
  • First Online:
Bariatric Surgery Complications and Emergencies

  • 1500 Accesses

Abstract

Since the introduction of laparoscopic Roux-en-Y gastric bypass in 1994, the incidence of small bowel obstruction due to internal hernias has been noted to increase. Several technical measures have been reported to decrease the incidence of internal hernia, including an antecolic Roux limb, closure of mesenteric defects, counterclockwise rotation of the Roux limb with right sided orientation, division of the omentum, and minimal to no division of the mesentery at the jejunojejunostomy. In patients who present with an internal hernia, symptoms are often nonspecific and radiologic imaging may be helpful for diagnosis. Multiple CT findings have been described that support the presence of an internal hernia. However, negative imaging results cannot exclude an internal hernia, and one must maintain a high index of suspicion in a symptomatic patient. Internal hernias are potentially life-threatening, and must be managed operatively. Diagnosis and repair should not be delayed due to the possibility of bowel strangulation and increased risk of morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.

    Article  PubMed  Google Scholar 

  2. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Jones KB, Afram JD, Benotti PN, Capella RF, Cooper CG, Flanagan L, Hendrick S, Howell LM, Jaroch MT, Kole K, Lirio OC, Sapala JA, Schuhknecht MP, Shapiro RP, Sweet WA, Wood MH. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg. 2006;16:721–7.

    Article  PubMed  Google Scholar 

  4. Obeid A, McNeal S, Breland M, Stahl R, Clements RH, Grams J. Internal hernia after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2014;18:250–6.

    Article  PubMed  Google Scholar 

  5. Husain S, Ahmed AR, Johnson J, Boss T, O’Malley W. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg. 2007;142:988–93.

    Article  PubMed  Google Scholar 

  6. Koppman JS, Li C, Gandsas A. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9527 patients. J Am Coll Surg. 2008;206:571–84.

    Article  PubMed  Google Scholar 

  7. Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:596–600.

    Article  PubMed  Google Scholar 

  8. Garza Jr E, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2004;188:796–800.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. Ahmed RA, Rickards G, Husain S, Johnson J, Boss T, O’Malley W. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17:1563–6.

    Article  PubMed  Google Scholar 

  11. Bauman RW, Pirrello JR. Internal hernia at Petersen’s space after laparoscopic Roux-en-Y gastric bypass: 6.2 % incidence without closure–a single surgeon series of 1047 cases. Surg Obes Relat Dis. 2009;5:565–70.

    Article  PubMed  Google Scholar 

  12. Elms L, Moon RC, Varnadore S, Teixeira AF, Jawad MA. Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2395 cases at a single institution. Surg Endosc. 2013;28:1624–8.

    Article  Google Scholar 

  13. Ortega J, Cassinello N, Sánchez-Antúnez D, Sebastián C, Martínez-Soriano F. Anatomical basis for the low incidence of internal hernia after a laparoscopic Roux-en-Y gastric bypass without mesenteric closure. Obes Surg. 2013;23:1273–80.

    Article  PubMed  Google Scholar 

  14. Blachar A, Federle MP. Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT. 2000;23:174–83.

    Article  Google Scholar 

  15. Faria F, Preto J, Oliveira M, Pimenta T, Baptista M, Costa-Maia J. Petersen’s space hernia: a rare but expanding diagnosis. Int J Surg Case Rep. 2011;2:141–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Paroz A, Calmes JM, Romy S, Giusti V, Suter M. A new type of internal hernia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19:527–30.

    Article  CAS  PubMed  Google Scholar 

  17. Cho M, Pinto D, Carrodeguas L, Lascano C, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP, Zundel N, Szomstein S, Rosenthal RJ. Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases. Surg Obes Relat Dis. 2006;2:87–91.

    Article  PubMed  Google Scholar 

  18. Escalano A, Devaud N, Pérez G, Crovari F, Boza C, Viviani P, Ibáñez L, Guzmán S. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis. 2007;3:423–7.

    Article  Google Scholar 

  19. Miyashiro LA, Fuller WD, Ali MR. Favorable internal hernia rate achieved using retrocolic, retrogastric alimentary limb in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:158–62.

    Article  PubMed  Google Scholar 

  20. Iannelli A, Buratti MS, Novellas S, Dhaman M, Amor IB, Sejo E, Facchiano E, Addeo P, Gugenheim J. Internal hernia as a complication of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17:1283–6.

    Article  PubMed  Google Scholar 

  21. de la Cruz-Muñoz N, Cabrera JC, Cuesta M, Hartnett S, Rojas R. Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7:176–80.

    Article  PubMed  Google Scholar 

  22. Brolin RE, Kella VN. Impact of complete mesenteric closure on small bowel obstruction and internal mesenteric hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9:850–4.

    Article  PubMed  Google Scholar 

  23. Aghajani E, Jacobsen HJ, Nergaard BJ, Hedenbro JL, Leifson BG, Gislason H. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg. 2012;16:641–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Walker AS, Bingham JR, Causey MW, Sebesta JA. Mesenteric irritation as a means to prevent internal hernia formation after laparoscopic gastric bypass surgery. Am J Surg. 2014;207:739–41.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Nandipati KC, Lin E, Husain F, Srinivasan J, Sweeney JF, Davis SS. Counterclockwise rotation of Roux-en-Y limb significantly reduces internal herniation in laparoscopic Roux-en-Y gastric bypass (LRYGB). J Gastrointest Surg. 2012;16:675–81.

    Article  PubMed  Google Scholar 

  27. Madan AK, Menzo EL, Dhawan N, Tichansky DS. Internal hernias and nonclosure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19:549–52.

    Article  PubMed  Google Scholar 

  28. Blachar A, Federle MP, Pealer KM, Ikramuddin S, Schauer P. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223:625–32.

    Article  PubMed  Google Scholar 

  29. Filip JE, Mattar SG, Bowers SP, Smith CD. Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Am Surg. 2002;68:640–3.

    PubMed  Google Scholar 

  30. Lockhart ME, Tessler FN, Canon CL, Smith JK, Larrison MC, Fineberg NS, Roy BP, Clements RH. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. Am J Roentgenol. 2007;188:745–50.

    Article  Google Scholar 

  31. Ahmed RA, Rickards G, Johnson J, Boss T, O’Malley W. Radiological findings in symptomatic internal hernias after laparoscopic gastric bypass. Obes Surg. 2009;19:1530–5.

    Article  PubMed  Google Scholar 

  32. Marchini AK, Denys A, Paroz A, Romy S, Suter M, Desmartines N, Meuli R, Schmidt S. The four different types of internal hernia occurring after laparoscopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction? Obes Surg. 2011;21:506–16.

    Article  Google Scholar 

  33. Onopchenko A. Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass. Obes Surg. 2005;15:606–11.

    Article  PubMed  Google Scholar 

  34. Iannuccilli JD, Grand D, Murphy BL, Evangelista P, Roye GD, Mayo-Smith W. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol. 2009;64:373–80.

    Article  CAS  PubMed  Google Scholar 

  35. Reddy SA, Yang C, McGinnis LA, Seggerman RE, Garza E, Ford III KL. Diagnosis of transmesocolic internal hernia as a complication of retrocolic gastric bypass: CT imaging criteria. Am J Roentgenol. 2007;189:52–5.

    Article  Google Scholar 

  36. Gandhi AD, Patel RA, Brolin RE. Elective laparoscopy for herald symptoms of mesenteric/internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5:144–9.

    Article  PubMed  Google Scholar 

  37. Tymitz K, Steele K, Schweitzer M. Laparoscopic single-incision repair of internal hernia defects using an intracorporeal suturing technique. Surg Obes Relat Dis. 2011;7:778–80.

    Article  PubMed  Google Scholar 

  38. Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005;19:34–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Alabama at Birmingham and Birmingham VA Medical Center, KB 401, 1720 2nd Ave South, Birmingham, AL, 35294, USA

    Britney Corey MD & Jayleen Grams MD, PhD

Authors
  1. Britney Corey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jayleen Grams MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jayleen Grams MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Daniel M. Herron

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Corey, B., Grams, J. (2016). Internal Hernias: Prevention, Diagnosis, and Management. In: Herron, D. (eds) Bariatric Surgery Complications and Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-27114-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27114-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27112-5

  • Online ISBN: 978-3-319-27114-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation