Different surgical techniques that influenced internal hernia prevalence rate after laparoscopic roux-en-Y gastric bypass: a retrospective analysis of 331 cases

Abstract

Background: Internal hernia (IH) is a serious complication following laparoscopic Roux-en-Y gastric bypass (LRYGB), and closure of mesenteric defect has been recommended to reduce this complication. But what kind of material about suture and how to close the mesenteric defects were still controversial. The main aim of this study was to compare the incidence rate of internal hernia after LRYGB between patients with different surgical techniques. Method: Three hundred and thirty-one patients underwent LRYGB between June 2004 and December 2017 in one single institute were retrospective analysed. The IH rate was evaluated according to different surgical methods and surgical materials before and 12 months after LRYGB. Results: All the cases were subdivided into three groups based on the suturing method, Roux limb position, and Suture material. The mean follow up time was 36 ± 12 months, and the total incident rate of IH was 1.8% (n = 6). In the six IH cases, the duration of IH occurred time ranged from 1 month to 36 months postoperatively, and for the IH sites, one for intestinal defect, three for transverse mesocolon defect and two Peterson defect respectively. There was a significant difference about IH rate between interrupted suture and running suture groups (p = 0.011), and there were no significant differences between the other two groups. Conclusion: Compare with interrupted suture, running suture may prevent IH after LRYGB. Patient's gender, age, body mass index(BMI), glycometabolism condition, and Roux limb position and suture material had no effects on the IH prevalence after LRYGB.

Medium-Term Outcomes from a Series of 1000 One Anastomosis Gastric Bypass in Australia: A Case Series

“…Although it is likely that recall bias and observer bias contribute to the low numbers in our cohort, it has been shown in the literature that dumping syndrome may be less common in patients undergoing OAGB [ 16 ]. Internal herniation occurs in up to 9–10% of patients undergoing RYGB [ 17 ]; we had no patients in our cohort with internal hernia and this appears in line with published data showing significantly lower rates of internal herniation related to OAGB [ 18 ]. Internal hernia can have significant sequelae, typically requiring emergent surgical intervention, possibly contributing to chronic vague symptoms in these patients [ 19 ].…”

Sutura barbada para el cierre de defectos mesentéricos tras bypass gástrico laparoscópico: ¿ha cambiado la incidencia de hernia interna en nuestra serie?

“…Si hablamos de la técnica, la mayoría de los autores están de acuerdo en emplear una sutura continua para el cierre de los DM (6,7) . Higa et al (7) afirma que los puntos entrecortados al conferir menos estanqueidad ocasionan un mayor índice de fracaso teniendo en cuenta la pérdida de peso posoperatoria y el progresivo adelgazamiento y elongamiento que van a sufrir los mesos de este tipo de pacientes.…”

“…En términos de materiales, los más utilizados en la literatura son las suturas irreabsorbibles. En el estudio retrospectivo de Yang et al (6) se puede observar como el cierre de los defectos con sutura irreabsorbible presenta menos casos de HI que el de sutura absorbible, aunque sus resultados no son estadísticamente significativos.…”

Falciform hernia following gastric bypass surgery case report

“…The location of these internal hernias tends to vary, though the most common site is the jejuno-jejunal window, followed by the Petersen's window, and then the meso-colic window (where applicable) [6]. It is thought that an antecolic approach results in fewer internal hernias than the retrocolic approach, given fewer hernia defects [7]. The presence of these mesenteric defects is associated with the development of internal hernias.…”