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Preventative laparoscopic repair of Petersen’s space following gastric bypass surgery reduces the incidence of Petersen’s hernia: a comparative study

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Abstract

Introduction

Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen’s internal hernia is one of the most frequent internal hernias following Bariatric surgery.

Methods

We describe our experience at a third-level surgical center using a prophylactic Petersen’s space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen’s space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures.

Results and conclusions

667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen’s space closure, 4 developed Petersen’s internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen’s space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen’s IH during the post-operative period following LGBP.

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Abbreviations

LGBP:

Laparoscopic gastric bypass

IH:

Internal hernia

PIH:

Petersen’s internal hernia

PH:

Petersen’s hernia

PS:

Petersen’s space

BS:

Bariatric surgery

JJ:

Jejunum Jejunostomy

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Correspondence to M. Pedraza.

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In the present study, the authors declare no conflict of interest and have no financial relationships with any commercial interest, since our only objective is to make a scientific contribution to humanity.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Lopera, C.A., Vergnaud, J.P., Cabrera, L.F. et al. Preventative laparoscopic repair of Petersen’s space following gastric bypass surgery reduces the incidence of Petersen’s hernia: a comparative study. Hernia 22, 1077–1081 (2018). https://doi.org/10.1007/s10029-018-1814-0

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