Two similar cases of internal hernia after laparoscopic Roux-en-Y gastric bypass surgery

Abstract

Internal hernia after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery can lead to acute small bowel obstruction or chronic recurrent abdominal pain. We present two cases of internal hernias after antecolic antegastric LRYGB. Both patients presented to the emergency room with acute diffuse abdominal pain. Other than that, a physical examination and routine laboratory workup did not reveal any pathological finding. An abdominal CT was performed in both cases. It showed mesenteric torsion as a sign of internal hernia in one case, but remained inconclusive in the other patient. Immediate diagnostic laparoscopy was performed in both cases. Intraoperatively, both patients revealed an internal hernia, where the common channel herniated through the mesojejunal space. The conversion to upper median minilaparotomy was necessary for hernia reduction in both cases. No bowel resection was required and both patients recovered fully.

Laparoscopic Resumption of Gastrointestinal Continuity of Unused Short Bowel Syndrome after Complicated RYGB Internal Hernia: A Case Report of the Unexpected Outcome

“…Despite the advent of newer bariatric surgical procedures over the last few decades with excellent outcomes, RYGB still holds its place as one of the oldest and most important restrictive and malabsorptive metabolic bariatric procedures, especially for patients who are suffering from gastroesophageal reflux disease (GERD) and/or metabolic syndrome [10]. However, IH is a peculiar complication of this procedure with an incidence rate ranging from 0.2% to 8%, with variability related to the chosen surgical technique [11][12].…”