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Strangulated Diaphragmatic Hernia Following Roux-en-Y Gastric Bypass: Surgical Pitfalls and Lessons Learned
Ahmed Abdelsalam1, Mohammed Elshal2, Ahmed Elansary2
1Cairo University, Giza, Egypt. a.abd.elsalam@kasralainy.edu.eg.
Introduction:
With the rising number of MBS and their revisions, rare complications may start to increase as well. Iatrogenic diaphragmatic hernia following metabolic and bariatric surgery (MBS) is extremely rare but potentially fatal. Its recognition is often delayed due to vague clinical presentations.
Purpose:
We report a case of strangulated diaphragmatic hernia after Roux-en-Y gastric bypass (RYGB) and gastro-gastric fistula dismantling, highlighting diagnostic and surgical pitfalls, and lessons for bariatric surgeons.
Methods:
We describe the presentation, diagnostic work-up, and surgical management of a diaphragmatic hernia after RYGB.
Results:
The patient had a smooth postoperative recovery but then developed pleural effusion requiring tapping. She had recovered fully with normal follow-up clinically and radiologically.
Conclusion:
This case highlights the importance of attention to such rare but life-threatening consequences after MBS. Precise use of energy devices intraoperatively, especially in revisional cases, is mandatory. A high index of suspicion for vague abdominal symptoms and tailored surgical strategies are essential.
Insights
A rare but fatal diaphragmatic hernia complication after metabolic and bariatric surgery (MBS) can occur. Prompt diagnosis and careful surgical technique are crucial for managing this life-threatening condition.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Safety
Background:
- Metabolic and bariatric surgery (MBS) is increasing, leading to a potential rise in rare complications.
- Iatrogenic diaphragmatic hernia is an extremely rare but potentially fatal complication of MBS.
- Delayed recognition of diaphragmatic hernia is common due to non-specific symptoms.
Purpose of the Study:
- To report a case of strangulated diaphragmatic hernia following Roux-en-Y gastric bypass (RYGB).
- To highlight diagnostic and surgical challenges associated with this rare complication.
- To provide lessons for bariatric surgeons on managing diaphragmatic hernias.
Main Methods:
- Case report detailing the presentation of a diaphragmatic hernia after RYGB.
- Description of the diagnostic work-up process.
- Explanation of the surgical management strategy employed.
Main Results:
- The patient experienced a smooth initial recovery post-RYGB.
- A subsequent pleural effusion developed, necessitating intervention.
- Full clinical and radiological recovery was achieved post-treatment.
Conclusions:
- Emphasizes the need for vigilance regarding rare, life-threatening MBS complications.
- Stresses the importance of precise intraoperative energy device use, particularly in revisional surgery.
- Highlights the necessity of a high index of suspicion for vague symptoms and tailored surgical approaches.
