TITLE

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

AUTHOR(S)
Filip, Jennifer E.; Mattar, Samer G.; Bowers, Steven P.; Smith, C. Daniel
PUB. DATE
July 2002
SOURCE
American Surgeon;Jul2002, Vol. 68 Issue 7, p640
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
There is mounting concern that internal hernia formation after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity remains unrecognized until complications develop. In this report we present our experience with this complication. Out of 100 patients who underwent LRYGB we identified five patients who were diagnosed with postoperative internal hernia formation. The medical records and operative details of these patients were reviewed. Of the five patients four were female and the average age was 36 years (range 30-43). All Roux limbs were placed in a retrocolic position. The average time interval to presentation was 104 days (range 4-305). All patients had abdominal pain and four patients experienced vomiting. One patient had obstipation. Only one patient had fever (38.1 Celsius) and the highest white cell count was 14,500. The average loss in body-mass index was 5.21 kg/m² (range 2.5-14.8). Plain abdominal films revealed dilated bowel in the upper abdomen in three patients. Contrast bowel series was diagnostic in only one patient. One patient had a CT scan, which was diagnostic of small bowel obstruction. All patients underwent operative reduction of the internal hernia; two of these were completed laparoscopically. All hernias had occurred at the mesocolic window and were caused by sutures that had pulled through tissue at the dorsal and lateral aspect of the initial repair. One patient had a nonviable segment of small bowel. There were no deaths. Patients who undergo LRYGB are at a 5 per cent risk for developing small bowel obstruction secondary to internal hernia formation at the mesocolic window. Clinical evaluation and traditional study modalities may not be effective diagnostic tools. A high index of suspicion and low threshold to explore these patients may be the best way to avoid serious sequelae. Modification of operative techniques may reduce the occurrence of internal hernia formation.
ACCESSION #
7752205

 

Related Articles

  • Laparoscopic Gastric Banding for Morbid Obesity. Weiner, R.; Wagner, D.; Bockhorn, H. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Feb99, Vol. 9 Issue 1, p23 

    Focuses on a study which examined the efficacy of laparoscopic adjustable gastric banding (LASGB), a gastric restrictive procedure, to treat morbid obesity. Materials and methods; Learning curve of LASGB; Postoperative complications.

  • Zero frequency of internal hernias after laparoscopic double loop gastric bypass without closure of mesenteric defects. Palmisano, Silvia; Giuricin, Michela; Casagranda, Biagio; Manzini, Nicolò // Surgery Today;Oct2014, Vol. 44 Issue 10, p1920 

    Purpose: Laparoscopic Roux-en-Y gastric bypass is among the most effective surgical procedures for morbid obesity; however, one of its most common long-term complications is internal hernia. The purpose of this study was to evaluate the incidence of internal hernia in patients undergoing a new...

  • The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese. Samakar, Kamran; McKenzie, Travis; Tavakkoli, Ali; Vernon, Ashley; Robinson, Malcolm; Shikora, Scott // Obesity Surgery;Jan2016, Vol. 26 Issue 1, p61 

    Background: The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients....

  • Laparoscopic herniorrhaphy: Technical concerns in prevention of complications and early recurrence. Tucker, Jeff G.; Wilson, Russell A. // American Surgeon;Jan1995, Vol. 61 Issue 1, p36 

    Discusses technical considerations in the prevention of complications and recurrence of laparoscopic herniorrhaphy. Intra and postoperative complications; Causes of recurrence.

  • The `other side' of pediatric hernias: The role of... Rescorla, Frederick J.; West, Karen W. // American Surgeon;Aug1997, Vol. 63 Issue 8, p690 

    Discusses the role of nonpuncture laparoscopy performed through the symptomatic hernia sac in identifying a contralateral patent processus vaginalis (CPPV) in neonates neonates, infants and children. Materials and methods used in the study;Technique of nonpuncture laparoscopy; Incidence of CPPV...

  • Randomized controlled trial of laparoscopic versus open mesh repair for inguinal hernia: Outcome... Wellwood, James; Schulpher, Mark J.; Stoker, David; Nichollas, Graham J.; Geddles, Cathy; Whitehead, Anne; Singh, Rameet; Spiegelhalter, David // BMJ: British Medical Journal (International Edition);07/11/98, Vol. 317 Issue 7151, p103 

    Provides information on a study comparing tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anesthetic. Methodology used to conduct the study; Characteristics of the patients used in the study; Details on...

  • Comparison of Laparoscopic and Open Ventral Herniorrhaphy. Ramshaw, Bruce J.; Esartia, Playton // American Surgeon;Sep1999, Vol. 65 Issue 9, p827 

    The repair of large and/or recurrent ventral hernias is associated with significant complications and a recurrence rate that can be more than 50 per cent. Laparoscopic ventral herniorrhaphy, a recent development, has been shown to be safe and effective in the repair of ventral hernias. This...

  • Laparoscopic Repair of Bilateral and Recurrent Hernias. Frankum, Charles E.; Ramshaw, Bruce J. // American Surgeon;Sep1999, Vol. 65 Issue 9, p839 

    The optimal inguinal hernia repair has been controversial for decades. Since the advent of minimally invasive surgery, laparoscopic techniques have added to the controversy. Laparoscopic hernia repair has been advocated by many experts for the repair of bilateral and recurrent inguinal hernias....

  • The critical technical aspects of laparoscopic repair of ventral and incisional hernias. Leblanc, Karl A.; LeBlanc, K A // American Surgeon;Aug2001, Vol. 67 Issue 8, p809 

    Several authors have revealed the utility of the laparoscopic approach to hernia defects that involve the ventral surface of the abdominal wall. The results of these series have been favorable. These authors all have recognized that appropriate sizing and fixation are important components of...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics