Internal hernias after laparoscopic Roux-en-Y gastric bypass

Garza, Ernesto; Kuhn, Joseph A.; Arnold, David; Nicholson, William J.; Reddy, Suraj; McCarty, Todd M.

doi:10.1016/j.amjsurg.2004.08.049

Cited by 157 publications

(99 citation statements)

References 6 publications

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“…4c) [2,3,7,10,20,21]. Some authors consider it the most common type of the four IH after LRYGBP [4,7,8,17,20,23], while in our series, it was the least frequent one, although the majority of our patients had a retrocolic Roux limb. This difference may be explained by the increasing attention surgeons attach to the initial closure of this particular mesenteric defect during …”

Section: Transmesocolic Herniacontrasting

confidence: 41%

The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?

et al. 2011

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Background Four different types of internal hernias (IH) are known to occur after laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for morbid obesity. We evaluate multidetector row helical computed tomography (MDCT) features for their differentiation. Methods From a prospectively collected database including 349 patients with LRYGBP, 34 acutely symptomatic patients (28 women, mean age 32.6), operated on for IH immediately after undergoing MDCT, were selected. Surgery confirmed 4 (11.6%) patients with transmesocolic, 10 (29.4%) with Petersen's, 15 (44.2%) with mesojejunal, and 5 (14.8%) with jejunojejunal IH. In consensus, 2 radiologists analyzed 13 MDCT features to distinguish the four types of IH. Statistical significance was calculated (p< 0.05, Fisher's exact test, chi-square test). Results MDCT features of small bowel obstruction (SBO) (n=25, 73.5%), volvulus (n=22, 64.7%), or a cluster of small bowel loops (SBL) (n=27, 79.4%) were inconsistently present and overlapped between the four IH. The following features allowed for IH differentiation: left upper quadrant clustered small bowel loops (p<0.0001) and a mesocolic hernial orifice (p=0.0003) suggested transmesocolic IH. SBL abutting onto the left abdominal wall (p= 0.0021) and left abdominal shift of the superior mesenteric vessels (SMV) (p=0.0045) suggested Petersen's hernia. The SMV predominantly shifted towards the right anterior abdominal wall in mesojejunal hernia (p=0.0033). Location of the hernial orifice near the distal anastomosis (p=0.0431) and jejunojejunal suture widening (p=0.0005) indicated jejunojejunal hernia. Conclusions None of the four IH seems associated with a higher risk of SBO. Certain MDCT features, such as the position of clustered SBL and hernial orifice, help distinguish between the four IH and may permit straightforward surgery.

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Section: Transmesocolic Herniacontrasting

confidence: 41%

The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?

et al. 2011

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“…Presentations can range from mild, colicky abdominal pain to complete bowel obstruction. With the incidence of internal hernia following Roux-en-Y gastric bypass ranging from 1 to 9%, the potential for intestinal strangulation in these patients should be considered and the possibility of internal hernia must be evaluated quickly [1][2][3][4][5][6][7][8][9].…”

mentioning

confidence: 99%

Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia

et al. 2010

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“…Higa et al [23] reported negative CT scanning for 20% of patients with internal hernias. In other series, CT scanning was diagnostic for 64% of patients with internal hernia [24].…”

Section: Diagnosismentioning

confidence: 93%

A complication of Roux-en-Y gastric bypass: intestinal obstruction

2007

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A high index of suspicion is needed to diagnose bowel obstruction after gastric bypass. Radiological imaging of the abdomen has significant limitations. Surgical exploration should be performed without delay. Diagnostic laparoscopy is a safe and effective therapy. We recommend closing all mesenteric defects to prevent internal hernias. The antecolic, antegastric technique reduces the incidence of internal hernias.

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Internal hernias after laparoscopic Roux-en-Y gastric bypass

Cited by 157 publications

References 6 publications

The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?

The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?

Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia

A complication of Roux-en-Y gastric bypass: intestinal obstruction

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