Internal hernia due to gastric bypass surgery

Internal hernias due to gastric bypass surgery are more common after laparoscopic gastric bypass than after an open procedure.

Epidemiology

Incidence after a Roux-en-Y gastric bypass may range between 1-16%. The presence of strangulation may be associated with a mortality rate exceeding 50% .

Clinical presentation

It is a particularly sinister complication with variable, non-specific clinical presentations. Most patients report a combination of postprandial abdominal pain, nausea and emesis . Patients may present at any time after surgery, however the majority are delayed, occurring after more than a month .

Physical examination findings are likewise non-specific, and may range from vague abdominal tenderness to palpation to peritonism .

Pathology

It has been suggested that patients are more prone to internal hernias after laparoscopic Roux-en-Y gastric bypass than after an open operation because there are fewer adhesions to tether small-bowel loops and prevent them from herniating. In addition, patients who have greater degrees of weight loss after laparoscopic Roux-en-Y gastric bypass may be more prone to internal hernia because of loss of the protective, space-occupying effect of mesenteric fat .

Types

Laparoscopic Roux-en-Y gastric bypass surgery produces three potential sites for internal hernia formation:

• at the defect in the transverse mesocolon through which the Roux limb passes (if it is placed in the retrocolic position)
• at the mesenteric defect at the enteroenterostomy
• behind the Roux limb mesentery placed in a retrocolic or antecolic position (retrocolic Petersen and antecolic Petersen type) 

Differential diagnosis

Postoperative complications which may present similarly after re-routing procedures include :

• anastomotic (staple line) leak
• marginal ulceration
• postoperative adhesions with obstruction
  • less common cause of small bowel obstruction in this population

See also 

• abdominal internal hernias
• complications of gastric bypass surgery

Siehe auch:

• innere Hernien
• Roux-en-Y-Magenbypass
• complications of gastric bypass surgery
• Petersen

und weiter:

• petersen’s hernia