Diagnosis and Management of Internal Hernias after Laparoscopic Gastric Bypass

Abstract

Small bowel obstruction in the post-LRYGBP patient is difficult to diagnose, especially when due to an internal hernia. Most patients present with intermittent abdominal pain and/or nausea. The most frequently used radiologic study is CT scan, which is most accurate when reviewed by the bariatric surgeon preoperatively.

Small-Bowel Volvulus in Late Pregnancy Due to Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

“…However, some authors questioned the superiority of the laparoscopic approach after reports of a higher rate of intestinal obstruction [3,6]. Thus, the development of internal hernias after laparoscopic Roux-en-Y gastric bypass has been reported in most studies with an incidence of up to 5%; in one single 3-year follow-up study of retrocolic versus antecolic laparoscopic Roux-en-Y gastric bypass, an overall incidence of 7.6% was found [3,4,[6][7][8][9][10]. The most common locations of the herniation are the meso-jejunal mesenteric window, the Peterson's mesenteric defect, and the mesocolic window [4].…”

Small Bowel Obstruction Creates a Closed Loop in Patients with a Laparoscopic Adjustable Gastric Band

“…Small bowel obstruction in this setting is a complication of the surgery itself, usually due to internal herniation of the small bowel around the Roux limb [8,9]. Medical practitioners are generally very aware of this association and are ready to intervene early.…”

Management of late postoperative complications of bariatric surgery

“…11). The incidence of symptomatic internal herniation ranges between 1·6 and 4·1 per cent 34,35 . Factors contributing to the development of internal hernias include failure to close the mesenteric defects, closure with absorbable rather than non-absorbable suture material, and the enlargement of these defects as patients lose weight.…”

“…More frequently, the onset of symptoms is insidious, with intermittent abdominal discomfort that occurs mainly after eating 35,36 .…”

“…Laparoscopy is an acceptable first option but often a formal laparotomy is indicated 35,36 . It is important for the surgeon to identify all limbs; this is best achieved by starting at the terminal ileum and working retrogradely to the JJ anastomosis and proximally to the Roux and BP limbs.…”