Laparoscopic Management of Complicated Internal Hernia After Proximal Jejunal Bypass (Video Report)

Abstract

Bariatric surgery plays an important role in weight management in current medical practice. Bypass procedures involve alternating the anatomic structure of alimentary tract to achieve malabsorption, which in turn leads to weight loss. Despite its low incidence, internal hernia can occur when an iatrogenic mesenteric defect is created during bariatric surgery. We herein report a video case of laparoscopic management of a complicated internal hernia after proximal jejunal bypass surgery. The patient was a 23-year-old woman who had undergone her first bariatric surgery of laparoscopic proximal jejunal bypass with gastric clipping 5 years earlier and revisional sleeve gastrectomy (SG) for weight regain 10 months prior to this admission. She presented to our emergency department with a complaint of intermittent cramping abdominal pain for the last 2 weeks. Physical examination revealed diffuse tenderness with mild muscle guarding. Computed tomography revealed a swollen and dilated segment of small bowel and some ascites in the pelvic region. Diagnostic laparoscopy was performed after confirming that a segment of the jejunum, adjacent to the previous jejuno-jejunal anastomosis (JJA), had herniated into the mesojejunal region. Subsequently, laparoscopic reduction of the twisted jejunum and resection of the ischemic segment of the biliopancreatic limb were performed. Redo JJA was performed and the mesenteric defect was closed with a running barbed suture. The postoperative course was uneventful, and the patient was discharged 8 days after surgery.