Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

Obeid, Ayman; McNeal, Sandre F.; Breland, Matthew; Stahl, Richard; Clements, Ronald H.; Grams, Jayleen

doi:10.1007/s11605-013-2377-0

Cited by 45 publications

(36 citation statements)

References 26 publications

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“…The false negative rate of CT in our study is consistent with previous reports that show a false negative rate of 13.5-17.8 % [11,32]. The mesenteric swirl sign was the most common CT finding in our patients.…”

Section: Discussionsupporting

confidence: 92%

Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass

et al. 2015

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Section: Discussionsupporting

confidence: 92%

Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass

et al. 2015

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“…A Petersen herniation was seen in half of those with an internal herniation in this study (22 of 42). In older studies, jejunojejunostomy hernias occurred more frequently than Petersen hernias, whereas more recent studies found more Petersen hernias, with rates ranging from 40·5 to 75 per cent. Defects were found to be equally distributed over the two sites in the present study.…”

Section: Discussionmentioning

confidence: 87%

“…Geubbels and colleagues 5 reported that cramping or colic pain was the most common symptom in patients with internal herniation. Abdominal pain, nausea or vomiting were the most common complaints in several previous studies 3,4,7,11,12 .…”

Section: Discussionmentioning

confidence: 90%

“…More recently, Altieri and colleagues noted a sensitivity of 76 per cent and a specificity of 60 per cent in a cohort of 50 patients. In other studies with even smaller study populations, the sensitivity of CT ranged from 40 to 83·3 per cent. The technical aspects of CT have, however, changed and improved over the past decade, and different CT signs have been described to improve the value of CT in diagnosing internal herniation (such as the swirl sign and venous congestion) ( Fig .…”

Section: Introductionmentioning

confidence: 76%

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Predictive value of abdominal CT in evaluating internal herniation after bariatric laparoscopic Roux-en-Y gastric bypass

Ederveen

Berckel

Nienhuijs

et al. 2018

British Journal of Surgery

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“…The number of patients included in studies (6)(7)(8) in which authors evaluated the CT signs associated with IH is relatively low (typically fewer than 20 patients per study). In addition, up to 20% of patients with IH may have CT findings negative for IH (9,10). Furthermore, diagnosis of IH with CT shows considerable interobserver variability, with wide ranges of reported diagnostic accuracy.…”

Section: Patientsmentioning

confidence: 99%

Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass: Optimal CT Signs for Diagnosis and Clinical Decision Making

et al. 2017

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q RSNA, 2016 Purpose:To evaluate the accuracy of computed tomography (CT) for diagnosis of internal hernia (IH) in patients who have undergone laparoscopic Roux-en-Y gastric bypass and to develop decision tree models to optimize diagnostic accuracy. Materials andMethods:This was a retrospective, ethics-approved study of patients who had undergone laparoscopic Roux-en-Y gastric bypass with surgically confirmed IH (n = 76) and without IH (n = 78). Two radiologists independently reviewed each examination for the following previously established CT signs of IH: mesenteric swirl, small-bowel obstruction (SBO), mushroom sign, clustered loops, hurricane eye, small bowel behind the superior mesenteric artery, and right-sided anastomosis. Radiologists also evaluated images for two new signs, superior mesenteric vein (SMV) "beaking" and "criss-cross" of the mesenteric vessels. Overall impressions for diagnosis of IH were recorded. Diagnostic accuracy and interobserver agreement were calculated, and multivariate recursive partitioning was performed to evaluate various decision tree models by using the CT signs. Results:Accuracy and interobserver agreement regarding the nine CT signs of IH showed considerable variation. The best signs were mesenteric swirl (sensitivity and specificity, 86%-89% and 86%-90%, respectively; k = 0.74) and SMV beaking (sensitivity and specificity, 80%-88% and 94%-95%, respectively; k = 0.83). Overall reader impression yielded the highest sensitivity and specificity (96%-99% and 90%-99%, respectively; k = 0.79). The decision tree model with the highest overall accuracy and sensitivity included mesenteric swirl and SBO, with a diagnostic odds ratio of 154 (95% confidence interval [CI]: 146, 161), sensitivity of 96% (95% CI: 87%, 99%), and specificity of 87% (95% CI: 75%, 93%). The decision tree with the highest specificity included SMV beaking and SBO, with a diagnostic odds ratio of 105 (95% CI: 101, 109), sensitivity of 90% (95% CI: 79%, 95%), and specificity of 92% (95% CI: 83%, 97%). Conclusion:The decision tree with the highest accuracy and sensitivity for diagnosis of IH included mesenteric swirl and SBO, the model with the highest specificity included SMV beaking and SBO, and the remaining signs showed lower accuracy and/or poor to fair interobserver agreement. Overall reader impression yielded the highest accuracy for diagnosis of IH, likely because alternate diagnoses not incorporated in the models were considered.q RSNA, 2016

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Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

Abstract: Closure of mesenteric defects and ante-colic Roux limb position result in a significantly lower IH rate. Furthermore, a high index of suspicion must be maintained since symptoms may be nonspecific and imaging may be negative in nearly 20 % of patients.

Cited by 45 publications

References 26 publications

Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass

Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass

Predictive value of abdominal CT in evaluating internal herniation after bariatric laparoscopic Roux-en-Y gastric bypass

Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass: Optimal CT Signs for Diagnosis and Clinical Decision Making

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