Internal Herniation in Pregnancy After Gastric Bypass

Vannevel, Valerie; Jans, Goele; Bialecka, Magdalena; Lannoo, Matthias; Devlieger, Roland; Mieghem, Tim Van

doi:10.1097/aog.0000000000001429

Cited by 55 publications

(35 citation statements)

References 31 publications

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“…Furthermore, a significant number of women, in particular, those in the younger age-group, experience increased fertility after bariatric surgery [28]. Although pregnancy has not been fully established as a risk factor for small bowel obstruction after laparoscopic gastric bypass surgery, the risk for small bowel obstruction is high during pregnancy in this group of patients [29,30]. Apart from handling of the mesenteric defects, none of these risk factors are preventable.…”

Section: Discussionmentioning

confidence: 99%

Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study

et al. 2019

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Background Routine closure of mesenteric defects is generally considered standard part of laparoscopic gastric bypass surgery today. Controversy still exists regarding the optimal method for mesenteric defects closure. The objective was to compare different methods for mesenteric defects handling in laparoscopic gastric bypass surgery. Methods Primary laparoscopic gastric bypass procedures from 2010 until 2015 reported to the Scandinavian Obesity Surgery Registry (SOReg), where the mesenteric defects closure method was identifiable, were included. Main outcome measures were serious postoperative complication within 30 days after surgery, and reoperation for small bowel obstruction within 5 years after surgery. Quality-of-life before and after surgery, duration of surgery, and risk factors for complication were also analyzed. Information on operation for small bowel obstruction was based on data from the SOReg, the Swedish National Patient Register and reviews of hospital charts. Results In all, 34,707 patients were included. Serious postoperative complication occurred in 174 (2.9%) patients with sutures, in 592 (3.1%, adjusted p = 0.079) with clips, and 278 (3.1%; adjusted p = 0.658) in the non-closure group. Reoperation for small bowel obstruction within 5 years after surgery was lower with sutures (cumulative incidence 6.9%) and clips (cumulative incidence 7.3%; adjusted HR 1.16, 95% CI 1.02-1.32, p = 0.026), compared to non-closure (cumulative incidence 11.2%; adjusted HR 1.63, 95% CI 1.44-1.84, p < 0.0001). Conclusion Closure of the mesenteric defects using either non-absorbable metal clips or non-absorbable running sutures is a safe and effective measure to reduce the risk for small bowel obstruction after laparoscopic gastric bypass surgery. Sutures appear slightly more effective and should remain gold standard for mesenteric defects closure.

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Section: Discussionmentioning

confidence: 99%

Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study

et al. 2019

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“…Substantial weight reduction after bariatric surgery gives an increased risk of developing an internal herniation. Pregnancy could increase this risk due to increased intra-abdominal pressure and displacement of the small intestine package due to the expansion of the uterus 1 4 5. This occurs in the second and especially third trimester of the pregnancy but can also occur without causal relation with the pregnancy in the first trimester, as was the case with patient B 1 5…”

Section: Discussionmentioning

confidence: 99%

“…However, the disadvantage of bariatric surgery is that it carries a risk of long-term complications. During pregnancy, these complications can lead to severe fetal and maternal morbidity and mortality 1. In this clinical lesson, we use two case studies to describe the importance of multidisciplinary expertise for a pregnant patient with abdominal pain due to complications from previous bariatric surgery.…”

Section: Introductionmentioning

confidence: 99%

Pregnant patient with acute abdominal pain and previous bariatric surgery

Leclercq¹,

Niemarkt

Laar

2019

BMJ Case Rep

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Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric–obstetric–neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen’s space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.

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“…Most of the reported literature advocates for the use of a CT scan 4. The sensitivity of CT scan to detect an IH is 76% (95% CI 54% to 90%), and the specificity is 60% (95% CI 39% to 78%) 11.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of an internal hernia in a pregnant woman with Roux-en-Y gastric bypass

Kannan¹,

Gupta

Gilchrist

et al. 2018

BMJ Case Reports

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Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal-fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain. She had a history of laparoscopic Roux-en-Y gastric bypass performed 3 years earlier. The clinical examination was remarkable for epigastric pain and tenderness. The vital signs and laboratory examinations were unremarkable. The CT scan was suggestive of an internal hernia. On an exploratory laparoscopy, the distal common small bowel was found to be herniating through the jejunojejunostomy mesenteric defect, causing intestinal obstruction with dilatation of the Roux limb and the biliopancreatic limb. The internal hernia was reduced, and no bowel resection was required. The mesenteric defect was closed with 3-0 silk sutures in a continuous fashion. The patient was discharged after 3 days and delivered a healthy baby at 40 weeks of gestation.

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Internal Herniation in Pregnancy After Gastric Bypass

Cited by 55 publications

References 31 publications

Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study

Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study

Pregnant patient with acute abdominal pain and previous bariatric surgery

Laparoscopic management of an internal hernia in a pregnant woman with Roux-en-Y gastric bypass

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