Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Iannelli, Antonio; Facchiano, Enrico; Gugenheim, Jean

doi:10.1381/096089206778663689

Cited by 192 publications

(142 citation statements)

References 41 publications

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“…We had no internal hernias, which was probably due to the antecolic position of the Roux limb [21] . Furthermore, the low incidence of anastomotic gastrointestinal stricture (0.8%) may be attributed to the use of 25 mm circular stapler.…”

Section: Discussionmentioning

confidence: 79%

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Vagenas¹,

Panagiotopoulos²,

Kehagias³

et al. 2008

WJG

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AIM:To evaluate and present our experience with laparoscopic Roux en Y gastric bypass (RYGB) in a selected patient population. METHODS: A cohort of 130 patients with a body mass index (BMI) between 35 and 50 kg/m 2 were evaluated in relation to postoperative morbidity, weight loss and resolution of co-morbidities for a period of 4 years following laparoscopic RYGB. RESULTS: Early morbidity was 10.0%, including 1 patient with peritonitis who was admitted to Intensive Care Unit (ICU) and 1 conversion to open RYGB early in the series. There was no early or late mortality. Maximum weight loss was achieved at 12 mo postoperatively, with mean BMI 30 kg/m 2 , mean percentage of excess weight loss (EWL%) 66.4% and mean percentage of initial weight loss (IWL%) 34.3% throughout the follow-up period. The majority of preexisting comorbidities were resolved after weight loss and no major metabolic disturbances or nutritional deficiencies were observed. CONCLUSION: Laparoscopic RYGB appears to be a safe and effective procedure for patients with BMI 35-50 kg/m 2 with results that are comparable to previously published data mostly from the USA but from Europe as well.

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Section: Discussionmentioning

confidence: 79%

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Vagenas¹,

Panagiotopoulos²,

Kehagias³

et al. 2008

WJG

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“…It does not involve any digestive anastomosis, no mesenteric defects are created eliminating the risk of internal hernia [54] , no foreign material is used as in the case of gastric banding, the whole digestive tract remains accessible to endoscopy, it is not associated with Dumping syndrome, the risk of peptic ulcer is low and the absorption of nutrients, vitamins, minerals and drugs is not altered.…”

Section: Pro and Cons Of Lsgmentioning

confidence: 99%

Laparoscopic sleeve gastrectomy for morbid obesity

Iannelli¹

2008

WJG

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127

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The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity. Bariatric surgery proved effective in providing weight loss of large magnitude, correction of comorbidities and excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage. The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very "trendy" among laparoscopic surgeons involved in bariatric surgery. As LSG proved to be effective in achieving considerable weight loss in the shortterm, it has been proposed by some as a sole bariatric procedure. This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity.

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“…The various forms of bariatric surgery include volume restriction (vertical banding), interventions causing malabsorption (jejunoileal bypass), and procedures that combine both, namely Roux-en-Y gastric bypass (RYGBP) [1,2]. RYGBP has been shown to be the most effective technique with a reported weight loss of 60-70% over a period of 10 years follow-up [3,4]. Therefore, RYGBP has now become the most commonly performed weight loss operation worldwide [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Likewise, postoperative intra-abdominal adhesions are less common. However, LRYGBP is associated with a relatively high incidence (0.8-5%) of internal hernias (IH), unlike open RYGBP [4,[6][7][8][10][11][12][13]. IH has even been reported to be the most frequent cause of small bowel obstruction (SBO) occurring after LRYGBP [14].…”

Section: Introductionmentioning

confidence: 99%

“…The surgical defects leading to the prolapse of small bowel loops have been known to occur at four different sites: either at the incised transverse mesocolon; at the Petersen's space, which represents an opening between the mesocolon and the Roux limb mesentery; at the jejunojejunostomy mesenteric defect, known as mesojejunal hernia; or, finally, at the suture of the two jejunal loops, the biliopancreatic and the Roux limb, called jejunojejunal hernia [3,4,[6][7][8][9][10][11][12][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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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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Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Abstract: IH after LRYGBP has an incidence of 2.51%. Closure of mesenteric defects with non-absorbable running suture and antecolic Roux limb are recommended. Surgical exploration for suspicion of IH after LRYGBP should be first done by laparoscopy.

Cited by 192 publications

References 41 publications

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Laparoscopic sleeve gastrectomy for morbid obesity

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?

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