Two Similar Cases of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass Surgery

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2013 Sep 28

PMID 24072825

Citations 1

Authors

Silvio Daster

Raoul A Droeser

Tarik Delko

Daniel Oertli

Affiliations

Soon will be listed here.

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.

Citing Articles

[Emergency during pregnancy after Roux-en-Y gastric bypass].

Hasenberg T, Gatje R, Niedergethmann M Chirurg. 2016; 87(7):604-6.

PMID: 26842124 DOI: 10.1007/s00104-015-0140-7.

References

Moore K, Ouyang D, Whang E . Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med. 2004; 351(7):721-2. DOI: 10.1056/NEJM200408123510722. View

Schneider C, Cobb W, Scott J, Carbonell A, Myers K, Bour E . Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc. 2010; 25(5):1594-8. DOI: 10.1007/s00464-010-1444-9. View

Bauman R, Pirrello J . Internal hernia at Petersen's space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure--a single surgeon series of 1047 cases. Surg Obes Relat Dis. 2009; 5(5):565-70. DOI: 10.1016/j.soard.2008.10.013. View

Lockhart M, Tessler F, Canon C, Smith J, Larrison M, Fineberg N . Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007; 188(3):745-50. DOI: 10.2214/AJR.06.0541. View

de la Cruz-Munoz N, Cabrera J, Cuesta M, Hartnett S, Rojas R . Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010; 7(2):176-80. DOI: 10.1016/j.soard.2010.10.003. View

Leyba J, Navarrete S, Navarrete Llopis S, Sanchez N, Gamboa A . Laparoscopic technique for hernia reduction and mesenteric defect closure in patients with internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass. Surg Laparosc Endosc Percutan Tech. 2012; 22(4):e182-5. DOI: 10.1097/SLE.0b013e3182550479. View

Kawkabani Marchini A, Denys A, Paroz A, Romy S, Suter M, Desmartines N . 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?. Obes Surg. 2011; 21(4):506-16. DOI: 10.1007/s11695-011-0364-7. View

ORourke R . Management strategies for internal hernia after gastric bypass. J Gastrointest Surg. 2011; 15(6):1049-54. DOI: 10.1007/s11605-010-1401-x. View

Comeau E, Gagner M, Inabnet W, Herron D, Quinn T, Pomp A . Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2004; 19(1):34-9. DOI: 10.1007/s00464-003-8515-0. View

10.

Abasbassi M, Pottel H, Deylgat B, Vansteenkiste F, Van Rooy F, Devriendt D . Small bowel obstruction after antecolic antegastric laparoscopic Roux-en-Y gastric bypass without division of small bowel mesentery: a single-centre, 7-year review. Obes Surg. 2011; 21(12):1822-7. DOI: 10.1007/s11695-011-0462-6. View

11.

Cho M, Pinto D, Carrodeguas L, Lascano C, Soto F, Whipple O . 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. Surg Obes Relat Dis. 2006; 2(2):87-91. DOI: 10.1016/j.soard.2005.11.004. View

12.

Flum D, Belle S, King W, Wahed A, Berk P, Chapman W . Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009; 361(5):445-54. PMC: 2854565. DOI: 10.1056/NEJMoa0901836. View

13.

Dixon J, Straznicky N, Lambert E, Schlaich M, Lambert G . Surgical approaches to the treatment of obesity. Nat Rev Gastroenterol Hepatol. 2011; 8(8):429-37. DOI: 10.1038/nrgastro.2011.112. View

14.

Gumbs A, Duffy A, Chandwani R, Bell R . Jejunojejunal anastomotic obstruction following laparoscopic Roux-en-Y gastric bypass due to non-absorbable suture: a report of seven cases. Obes Surg. 2006; 16(1):12-5. DOI: 10.1381/096089206775222131. View

15.

Suter M, Donadini A, Romy S, Demartines N, Giusti V . Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011; 254(2):267-73. DOI: 10.1097/SLA.0b013e3182263b66. View

16.

Steele K, Prokopowicz G, Magnuson T, Lidor A, Schweitzer M . Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc. 2008; 22(9):2056-61. DOI: 10.1007/s00464-008-9749-7. View

17.

DeMaria E . Bariatric surgery for morbid obesity. N Engl J Med. 2007; 356(21):2176-83. DOI: 10.1056/NEJMct067019. View

18.

Iannelli A, Buratti M, Novellas S, Dahman M, Amor I, Sejor E . Internal hernia as a complication of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007; 17(10):1283-6. DOI: 10.1007/s11695-007-9229-5. View

19.

Madan A, Lo Menzo E, Dhawan N, Tichansky D . Internal Hernias and Nonclosure of Mesenteric Defects During Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg. 2008; 19(5):549-52. DOI: 10.1007/s11695-008-9722-5. View

20.

Torres-Villalobos G, Kellogg T, Leslie D, Antanavicius G, Andrade R, Slusarek B . Small bowel obstruction and internal hernias during pregnancy after gastric bypass surgery. Obes Surg. 2008; 19(7):944-50. DOI: 10.1007/s11695-008-9681-x. View