Internal hernia after laparoscopic Roux-en-Y gastric bypass

Area of Science:

• Bariatric Surgery
• Surgical Outcomes
• Gastrointestinal Surgery

Background:

• Internal hernias (IH) are a complication of laparoscopic Roux-en-Y gastric bypass (LRYGB).
• Mesenteric defect closure and Roux limb position are potential factors influencing IH rates.

Purpose of the Study:

• To evaluate the impact of mesenteric defect closure and Roux limb position on the incidence of internal hernias following LRYGB.

Main Methods:

• Retrospective review of LRYGB patients from 2001-2011.
• Comparison of IH rates between patients with closed (DC) versus non-closed (DnC) mesenteric defects.
• Analysis of IH rates based on ante-colic versus retro-colic Roux limb position.

Main Results:

• A total of 914 patients were reviewed; 46 (5%) developed symptomatic IH.
• Patients with closed defects had a lower IH rate (3.8%) compared to those with non-closed defects (8.4%) (p=0.005).
• Ante-colic Roux limb position was associated with a lower IH rate (3.8%) versus retro-colic position (8.5%) (p=0.005).

Conclusions:

• Mesenteric defect closure and ante-colic Roux limb position are associated with significantly lower internal hernia rates after LRYGB.
• A high index of suspicion is crucial for diagnosing IH, as symptoms can be nonspecific and imaging results may be negative in a significant portion of cases.