Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management

Abdelrahman A Nimeri; Ahmed Maasher; Talat Al Shaban; Elnazeer Salim; Maysoon M Gamaleldin

doi:10.1007/s11695-016-2267-0

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Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management

Journal article

Peer reviewed

Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management

Abdelrahman A Nimeri, Ahmed Maasher, Talat Al Shaban, Elnazeer Salim and Maysoon M Gamaleldin

Obesity surgery, Vol.26(9), pp.2255-2256

09/2016

DOI: 10.1007/s11695-016-2267-0

PMID: 27365147

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Abstract

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the golden standard for bariatric surgery. However, the potential risk for internal hernia after LRYGB remains a significant concern to both patients and surgeons. In addition, patients presenting with abdominal pain after LRYGB warrant careful attention to avoid missing or delaying the diagnosis of internal hernia. The aim of this study was to describe our technique to prevent internal hernia after LRYGB, intra-operative findings, and our management strategies for patients with internal hernia after LRYGB. In this video, we review different technical tips and tricks to explore patients with suspected internal hernia after RYGB, how to reduce obstructed small bowel, and effectively close mesenteric defects to prevent internal hernia after LRYGB. A high index of suspicion and evaluation of the CT scan of the patient by an experienced bariatric surgeon is essential to avoid missing cases of internal hernia after LRYGB. In addition, patients presenting with incarcerated small bowel due to an internal hernia are best managed by standing on the left side of the patient with the left arm tucked and starting at the ileocecal valve and running the small bowel backwards towards the ligament of Treitz. Furthermore, patients with bowel obstruction due to internal hernia may need to have a gastrostomy placed at the remnant of the stomach. Recurrent abdominal pain is not uncommon after LRYGB. Systematic closure of mesenteric defects, the use of diagnostic laparoscopy, and high index of suspicion are all necessary to avoid delay in diagnosis.

Gastric Bypass - adverse effects

Gastric Bypass - methods

Hernia, Abdominal - diagnosis

Hernia, Abdominal - prevention & control

Humans

Laparoscopy - adverse effects

Laparoscopy - methods

Obesity, Morbid - surgery

Postoperative Complications - diagnosis

Postoperative Complications - prevention & control

Details

Title: Subtitle: Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management
Creators: Abdelrahman A Nimeri - Shaikh Khalifa Medical City
Ahmed Maasher - Shaikh Khalifa Medical City
Talat Al Shaban - Shaikh Khalifa Medical City
Elnazeer Salim - Shaikh Khalifa Medical City
Maysoon M Gamaleldin - Accreditation Council for Graduate Medical Education
Resource Type: Journal article
Publication Details: Obesity surgery, Vol.26(9), pp.2255-2256
DOI: 10.1007/s11695-016-2267-0
PMID: 27365147
NLM abbreviation: Obes Surg
ISSN: 0960-8923
eISSN: 1708-0428
Language: English
Date published: 09/2016
Academic Unit: Surgery
Record Identifier: 9984966753502771

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