Abstract
Background
Laparoscopic Roux-en-Y gastric bypass surgery reportedly has a higher rate of postoperative internal hernias than open bypass surgery. Even with closure of mesenteric defects, hernias occur in up to 9% of cases. To minimize this complication, an antecolic antegastric approach to anastomosis of the Roux limb and gastric pouch has been used. Whereas the retrocolic retrogastric technique creates three mesenteric defects, the antecolic approach produces only two: Petersen’s defect and the jejunojejunostomy. The rate of internal hernias was compared among patients undergoing laparoscopic Roux-en-Y gastric bypass surgery using the retrocolic and antecolic approaches.
Methods
The experience of a single surgeon from August 2001 to September 2005 was reviewed. Only Roux-en-Y gastric bypass procedures were included. Patients were followed for a minimum of 18 months postoperatively. The retrocolic approach was used for 274 patients and the antecolic approach for 205 patients. All defects were closed at the time of surgery. With the antecolic approach, Petersen’s defect was closed from the root of the mesentery of the Roux limb and the transverse colon mesentery up to the transverse colon.
Results
Of the 274 patients, 7 (2.6%) experienced a symptomatic internal hernia with the retrocolic retrogastric technique. No internal hernias were reported among the 205 patients treated with the antecolic antegastric method. Chi-square analysis showed that an antecolic approach was associated with a decreased rate of internal hernias (p < 0.025). Of 479 patients, 35 (7%) underwent diagnostic laparoscopy without any internal hernia found. Of these patients, 15 were found to have cholelithiasis and subjected to laparoscopic cholecystectomy.
Conclusions
The antecolic antegastric approach to laparoscopic Roux-en-Y gastric bypass is associated with fewer postoperative hernias than the retrocolic retrogastric approach. The frequency of hernias using either technique is low if meticulous attention is paid to closure of all mesenteric defects.
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References
Iannelli A, Facchiano E, Gugenheim J (2006) Internal hernia after laparoscopic Roux-en Y gastric bypass for morbid obesity. Obe Surg 16:1265–1271
Carmody B, DeMaria EJ, Johnson JM, Carbonell A, Kellum J, Maher J (2005) Internal hernia after laparoscopic Roux-en Y gastric bypass. Surg Obes Relat Dis 1:511–516
Quebbemann B, Dallal R (2005) The orientation of the antecolic Roux limb markedly affects the incidence of internal hernias after laparoscopic gastric bypass. Obes Surg 15:766–770
Paroz A, Calmes JM, Suter M (2006) Internal hernia after laparoscopic Roux-en Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg 16:1482–1487
Cho M, Pinto D, Carrodeguas L, Lascano C, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP, Zundel N, Szomstein S, Rosenthal RJ (2006) Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases. Surg Obes Relat Dis 2:87–91
Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en Y gastric bypass: incidence, treatment, and prevention. Obes Surg 13:350–354
Taylor J, Leitman M, Rosser J, Bavis B, Goodman E (2006) Does the position of the alimentary limb in Roux-en-Y gastric bypass surgery make a difference? J Gastrointest Surg 10:1397–1399
Garza E, Kuhn J, Arnold D, Nicholasm W, Reddy S, Mcarty T (2004) Internal hernias after laparoscopic Roux-en Y gastric bypass. Am J Surg 188:796–800
Nguyen NT, Huerta S, Gelfand D, Stevens CM, Jim J (2004) Bowel obstruction after laparoscopic Roux-en Y gastric bypass. Obes Surg 14:190–196
Champion JK, Williams M (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en Y gastric bypass. Obes Surg 13:596–600
Comeau E, Gagner M, Inabet WB, Heron DM, Quinn TM, Pomp A (2005) Symptomatic internal hernias after laparoscopic gastric bypass. Obes Surg 15:766–770
Jeansonne LO, Morgenthal CB, White BC, Lin E (2007) Internal hernia after laparoscopic gastric bypass: a review of the literature. Bariatric Times, April 2007, Surgical Perspective
Schweitzer MA, DeMaria EJ, Broderick TJ, Sugerman HJ (2000) Laparoscopic closure of mesenteric defects after Roux-en Y gastric bypass. J Laparoendosc Adv Surg Tech 10:173–175
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Presented at the 2007 Society of American Endoscopic Surgeons (SAGES) meeting in Las Vegas, SS16: Outcomes, Presentation: S097, Sunday 22 April 2007
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Steele, K.E., Prokopowicz, G.P., Magnuson, T. et al. Laparoscopic antecolic Roux-En-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc 22, 2056–2061 (2008). https://doi.org/10.1007/s00464-008-9749-7
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DOI: https://doi.org/10.1007/s00464-008-9749-7