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

Author: Iannelli A, Facchiano E, Gugenheim J

Author affiliation: Service de Chirurgie Digestive et Transplantation Hepatique, Hopital Archet, Nice, France. antonio_iannelli@hotmail.com

Publication date & source: 2006.10, Obes Surg., 16(10):1265-71.

Publication type: Review

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.