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Biliopancreatic Limb Obstruction Due to an Unexpected Variant of Internal Hernia After Roux-en-Y Gastric Bypass


Small bowel obstruction due to internal hernia (IH) is a well-known late complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). A reliable and immediate diagnosis of IH is important for optimal and timely management of patients with a history of LRYGB. Mesenteric defects that are created during a LRYGB include the following: (1) through the transverse mesocolon defect, (2) through the entero-enterostomy mesenteric defect, and (3) through the space between the mesentery of Roux limb and transverse mesocolon (Petersen’s space). The aim of this case is to present an unusual variant of IH after LRYGB that was laparoscopically explored and treated.

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  1. Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg. 2019;29(3):782–95.

    Article  Google Scholar 

  2. Ianelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–71.

    Article  Google Scholar 

  3. Higa K, Boone K, Arteaga González I, et al. Mesenteric closure in laparoscopic gastric bypass: surgical technique and literature review. Cir Esp. 2007;82(2):77–88.

    Article  Google Scholar 

  4. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–91.

    CAS  Article  Google Scholar 

  5. Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.

    Article  Google Scholar 

  6. Paroz A, Calmes JM, Romy S, et al. A new type of internal hernia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19(4):527–30.

    CAS  Article  Google Scholar 

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Correspondence to Nasser Sakran.

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Dar, R., Dola, T. & Sakran, N. Biliopancreatic Limb Obstruction Due to an Unexpected Variant of Internal Hernia After Roux-en-Y Gastric Bypass. OBES SURG 30, 5184–5185 (2020).

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  • Biliopancreatic limb
  • Internal hernia
  • Laparoscopic Roux-en-Y gastric bypass
  • Morbid obesity
  • Small bowel obstruction