Internal hernia (IH) represents the most common cause of small-bowel obstruction after laparoscopic RYGBP. The anatomic changes resulting from RYGBP, the use of laparoscopy, and the postoperative weight loss all account for the high incidence of IH after this procedure. As the symptoms may be very vague, the interpretation of the clinical picture may result difficult. Moreover, laparoscopic treatment of IH could be very challenging for surgeons not familiar with the modified intestinal anatomy of the RYGBP.
The video shows the management of an IH at the Petersen’s defect.
A 51-year-old female was assessed for recurrent abdominal pain 3 years after a RYGBP. A CT scan showed the mesenteric swirl sign, so a diagnostic laparoscopy was performed.
The video first shows the identification of the herniated bowel through the mesenteric defect. Then, complete reduction of the IH and the closure of the Petersen’s defect are shown.
The total operative time was 35 min. The postoperative stay was uneventful and the patient was discharged in postoperative day one.
In case of clinical suspicion of IH, even in case of normal laboratory and radiological findings, a surgical exploration is indicated.
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Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16(10):1265–71. eng.
Obeid A, McNeal S, Breland M, Stahl R, Clements RH, Grams J. Internal hernia after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2013;18(2):250–5. discussion 5–6. eng.
Onopchenko A. Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass. Obes Surg. 2005;15(5):606–11.
Garrard CL, Clements RH, Nanney L, Davidson JM, Richards WO. Adhesion formation is reduced after laparoscopic surgery. Surg Endosc. 1999;13:10–13.
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(6):766–70.
Facchiano E, Iannelli A, Gugenheim J, Msika S. Internal hernias and nonclosure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20(5):676–8. eng.
Conflict of Interest
The authors declare that they have no proprietary, financial, professional, or other personal interest of any nature or kind in any product or service that may influence the position presented.
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.
Informed consent was obtained by all individual participants included in the study.
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Facchiano, E., Leuratti, L., Veltri, M. et al. Laparoscopic Management of Internal Hernia After Roux-en-Y Gastric Bypass. OBES SURG 26, 1363–1365 (2016) doi:10.1007/s11695-016-2179-z
- Internal hernia
- Roux-en-Y gastric bypass
- Bariatric surgery
- Intestinal obstruction