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Internal hernia in patients after duodenal switch: A multi-centred comparative analysis.

Romulo P Lind¹, Estela Abich¹, Graziella Galvao Goncalves¹

¹Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida, USA.

Clinical Obesity

|December 18, 2024

Summary

Internal hernias (IH) are a risk after bariatric surgery like biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodeno-ileostomy with sleeve (SADI-S). This study found a lower IH rate in SADI-S compared to BPD-DS, suggesting potential safety benefits.

Keywords:

bariatric surgery biliopancreatic diversion with duodenal switch duodenal switch internal hernia

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Area of Science:

Bariatric Surgery
Gastrointestinal Surgery
Surgical Complications

Background:

Biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodeno-ileostomy with sleeve (SADI-S) offer significant weight loss.
Long-term safety, especially internal hernia (IH) risk, requires further investigation for these popular procedures.

Purpose of the Study:

To evaluate the incidence and characteristics of internal hernias (IH) after BPD-DS and SADI-S.
To compare the clinical presentation, diagnosis, and outcomes of IH between BPD-DS and SADI-S.

Main Methods:

Retrospective chart review of 1160 patients undergoing BPD-DS or SADI-S between 2008-2023.
Analysis of demographic data, comorbidities, operative details, and follow-up outcomes.
Subgroup analysis of IH cases to compare incidence, location, and diagnostic modalities.

Main Results:

Overall IH incidence was 1.12%, with higher rates in BPD-DS (0.8%) than SADI-S (0.57%).
Most IHs occurred within 24 months postoperatively, primarily in the pseudo-Petersen's space for both procedures.
Abdominal pain was the common presentation, with CT imaging being the main diagnostic tool.

Conclusions:

SADI-S demonstrated a lower IH rate compared to BPD-DS, warranting further investigation.
Variability in IH presentation necessitates heightened clinical vigilance for accurate diagnosis.