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Obesity Surgery

, Volume 25, Issue 4, pp 622–627 | Cite as

Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass: a Correlation Between Radiological and Operative Findings

  • Françis GoudsmedtEmail author
  • Bert Deylgat
  • Kenneth Coenegrachts
  • Kris Van De Moortele
  • Bruno Dillemans
Original Contributions

Abstract

Background

Even though internal hernia (IH) after a laparoscopic Roux-en-Y gastric bypass (LRYGB) is a well-known entity for bariatric surgeons and radiologists, accurate diagnosis remains difficult. The aim of this study was to evaluate the sensitivity and specificity of ten different CT findings in patients with a proven internal hernia after a LRYGB.

Methods

A retrospective analysis of all LRYGB patients who underwent an explorative laparoscopy for abdominal pain has been performed. Preoperative CT scans were individually reviewed by two radiologists specialized in abdominal CT imaging in a randomized blind way. These results were compared with the operative reports.

Results

Between 2004 and 2013, 7,328 patients underwent a LRYGB. One hundred sixty nine of these patients underwent an explorative laparoscopy for abdominal pain after a LRYGB, 131 of which had a preoperative CT scan. Of these 131 patients, 72 suffered from an IH. Fifty-nine patients had no IH and served as control group. Mesenteric swirl was the best predictor with for reader 1 a sensitivity of 68 % and specificity of 86 % and for reader 2 a sensitivity of 89 % and specificity of 63 %. Other signs had an even larger interobserver variability.

Conclusions

A CT scan can help in confirming the diagnosis of an IH, especially if a mesenteric swirl is present. However, since the presented sensitivities are variable and do not reach 100 %, IH might be missed, implicating that a high index of suspicion with a low threshold for explorative laparoscopy/-tomy remains the cornerstone of appropriate treatment.

Keywords

Gastric bypass Internal hernia Complication Obstruction Radiology Peterson 

Notes

Conflict of Interest

None of the authors (F. Goudsmedt, B. Deylgat, Kenneth Coenegrachts, Kris Van De Moortele, Bruno Dillemans) have conflicts of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study. No identifying information was used in this study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Françis Goudsmedt
    • 1
    Email author
  • Bert Deylgat
    • 1
  • Kenneth Coenegrachts
    • 2
  • Kris Van De Moortele
    • 2
  • Bruno Dillemans
    • 1
  1. 1.Department of General SurgeryAZ Sint Jan Brugge-OostendeBruggeBelgium
  2. 2.Department of RadiologyAZ Sint Jan Brugge-OostendeBruggeBelgium

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