Operative Complications During Pregnancy After Gastric Bypass—a Register-Based Cohort Study

Abstract

The incidence of internal herniation during pregnancy was 1 % in our study. Internal herniation may be a serious complication in pregnant women, and both the diagnosis and treatment requires handling by experienced obstetrical, radiological, and surgical staff.

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

“…RYGB results in potential internal spaces that predispose to internal herniation, which can be exacerbated by increased intra-abdominal pressure from a gravid uterus [133]. Women should be assessed by a bariatric surgeon, and diagnoses such as band slippage/erosion, herniation, small bowel obstruction and intussusception should be considered [91,102,134]. In addition, women presenting with hyperemesis gravidarum following RYGB are at increased risk of Wernicke's encephalopathy, and treatment with parenteral vitamin B1 should be considered [5].…”

Pregnant patient with acute abdominal pain and previous bariatric surgery

“…The weight loss leads to a reduction of obesity-related complications for both the pregnant woman (hypertensive disorders, gestational diabetes) and her child (macrosomia) 4 5. However, serious complications that affect mother and/or child can also occur.…”

“…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…”

“…Ultrasound has a particularly low sensitivity and specificity. Additional diagnostics, without radiation exposure, in the form of an MRI of the abdomen (without contrast) is still the most valuable and safest method, but it can be very difficult to correctly interpret the images due to the displacement of the small intestine package during pregnancy 5. In one of the described cases a CT scan was performed in the referring hospital prior to the actual referral to our centre.…”

Nonobstetric anesthesia during pregnancy

“…Andreasen and colleagues [31] analysed the data from a Danish register-based cohort study and found an incidence of 1% of women with a history of gastric bypass surgery who required surgery during pregnancy for internal herniation.…”