Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity

Obes Surg. 2006 Oct;16(10):1265-71. doi: 10.1381/096089206778663689.

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a relatively high incidence of internal hernias (IH) when compared to the open operation.

Methods: A search in PubMed MEDLINE from January 1994 through January 2006 was performed (keywords: obesity, laparoscopy, gastric bypass and internal hernia).

Results: 26 studies with a total of 11,918 patients were considered. 300 cases of IH occurred (rate 2.51%). IH occurred 116 times at the level of the transverse colon mesentery (69%), 30 at the Petersen's space (18%), and 22 at the entero-enterostomy site (13%). 142 re-operations were performed laparoscopically (85.6%), and 24 by laparotomy (14.4%). Bowel resection was done in 5 cases (4.7%). Mortality was 1.17%.

Conclusions: IH after LRYGBP has an incidence of 2.51%. Closure of mesenteric defects with non-absorbable running suture and antecolic Roux limb are recommended. Surgical exploration for suspicion of IH after LRYGBP should be first done by laparoscopy.

Publication types

  • Review

MeSH terms

  • Gastric Bypass / adverse effects*
  • Gastric Bypass / methods
  • Hernia / diagnosis
  • Hernia / epidemiology
  • Hernia / etiology*
  • Humans
  • Incidence
  • Laparoscopy / adverse effects*
  • Obesity, Morbid / surgery
  • Postoperative Complications / epidemiology
  • Suture Techniques