Internal hernia trends following gastric bypass surgery

Area of Science:

• Bariatric Surgery
• Gastrointestinal Surgery
• Surgical Complications

Background:

• Internal hernia is a known complication of laparoscopic Roux-en-Y gastric bypass (LRYGB), potentially causing small bowel obstruction.
• Mesenteric defect closure became more routine around 2010, yet large population-based studies on post-LRYGB internal hernia rates are scarce.

Purpose of the Study:

• To analyze trends in internal hernia incidence following LRYGB over two decades using a statewide database.
• To characterize the long-term occurrence of internal hernia complications after LRYGB.

Main Methods:

• Utilized New York SPARCS database for LRYGB records (2005-2015).
• Excluded patients under 18, in-hospital deaths, revisions, and simultaneous hernia repair.
• Applied multivariable proportional sub-distribution hazards model to assess 3-year post-LRYGB internal hernia trends.

Main Results:

• Identified 46,918 LRYGB patients; 6.29% (2950) had internal hernia repair by 2018.
• Cumulative 3-year incidence was 4.80%; by year 13, it reached 12.00%.
• A significant decreasing trend in 3-year post-LRYGB internal hernia repair was observed (HR=0.94).

Conclusions:

• This study confirms internal hernia rates similar to smaller studies but with longer follow-up.
• Demonstrates a decreasing incidence of internal hernia after LRYGB correlated with the year of surgery.
• Highlights the continued importance of monitoring internal hernia as a post-LRYGB complication.