Bypassing the bypass: complex laparoscopic reparation of internal hernia after laparotomic Roux-en-Y gastric bypass

We present the case of a patient with subocclusive crisis 1 year after undergoing Roux en-Y gastric bypass with an open approach. Laparoscopic exploration revealed a chylous ascites caused by an internal hernia through Petersen's space; we found a technical error involving the creation of the jejuno-jejunal anastomosis below the alimentary limb, causing the inability to achieve the complete reduction of herniated small bowel. After the reduction of internal hernia, a new anastomosis was created between alimentary limb and bilio-pancreatic limb, bypassing the tract under the alimentary limb, and then Petersen's space was closed.