Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 250–256

Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

  • Ayman Obeid
  • Sandre McNeal
  • Matthew Breland
  • Richard Stahl
  • Ronald H Clements
  • Jayleen Grams
2013 SSAT Plenary Presentation

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 surgery Laparoscopic gastric bypass Internal hernia 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Ayman Obeid
    • 2
  • Sandre McNeal
    • 2
  • Matthew Breland
    • 2
  • Richard Stahl
    • 2
  • Ronald H Clements
    • 1
  • Jayleen Grams
    • 2
  1. 1.Department of SurgeryVanderbilt UniversityNashvilleUSA
  2. 2.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA

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