• Obesity surgery · Oct 2006

    Review

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

    • Antonio Iannelli, Enrico Facchiano, and Jean Gugenheim.
    • Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet, Nice, France. antonio_iannelli@hotmail.com
    • Obes Surg. 2006 Oct 1; 16 (10): 1265-71.

    BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a relatively high incidence of internal hernias (IH) when compared to the open operation.MethodsA search in PubMed MEDLINE from January 1994 through January 2006 was performed (keywords: obesity, laparoscopy, gastric bypass and internal hernia).Results26 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%.ConclusionsIH 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.

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