Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases

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

“…Although all potential hernia defects were closed at the time of the initial surgery with absorbable braided suture to prevent possible hernia, IH still occurred. Some authors believe that no specific closure is needed while others argue that a permanent suture should be used [3,7,10]. On detailed analysis, no final word has been conclusively written about the dilemma.…”

“…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].Unfortunately, there are no good indices that predict which patients will develop an internal hernia after gastric bypass. We reviewed the gastric bypass patients who presented to our practice with an internal hernia so as to determine if there were any reliable factors heralding this…”

Laparoscopic antecolic Roux-En-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach

“…The rate of internal hernia with use of a laparoscopic approach reportedly is 0.2% to 9% [2,5] and generally is thought to be higher than with an open approach. This may be due to increased mobility of the viscera because of decreased scar tissue and adhesion formation, or it may result from failure to close the mesenteric defects [6,7].…”

Long-Term Consequences of Not Closing the Mesenteric Defect After Laparoscopic Right Colectomy

“…These studies may not be generalizable to laparoscopic colorectal resection. [2][3][4][5][6][7][8] Only 6 case reports of internal hernia following laparoscopic colectomy have been published. 9 -14 These reviews are limited in scope and do not resolve the controversy regarding the mesenteric defect.…”