Maria S Altieri1, Aurora D Pryor2, Dana A Telem2, Keneth Hall3, Collin Brathwaite3, Marlene Zawin4. 1. Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York. Electronic address: maria.altieri@stonybrookmedicine.edu. 2. Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York. 3. Division of Bariatric Surgery Program, Department of Surgery, Winthrop University Hospital, Mineola, New York. 4. Department of Radiology, Stony Brook Medical Center, Stony Brook, New York.
Abstract
BACKGROUND: While surgical exploration remains the gold standard for diagnosing internal hernia (IH) after certain bariatric surgeries, decisions for operative intervention are often based on computed tomography (CT) findings. OBJECTIVES: The aim of this study is to review our institutional experience and create an algorithm to approach patients presenting with abdominal pain and/or emesis after certain bariatric procedures. SETTINGS: University Hospital METHODS: Following institutional review board approval, a retrospective chart review of all patients presenting with obstruction symptoms after laparoscopic Roux-en-Y gastric bypass (LRYGB) was performed at 2 institutions from 2008 to 2013. Patients without CT scans or with incidental hernia defect findings were excluded. CT and intraoperative findings were compared via univariate statistical analysis. RESULTS: Fifty-two patients who underwent an operation for a suspected IH were identified. Of the 50 patients, 25 (50%) had IH at operation. Twenty-nine patients (58%) had positive CT scans read for IH and/or obstruction. Of these 29, 19 (66%) were found to have IH at operation and 10 (34%) underwent negative diagnostic laparoscopy. Of the 21 patients with negative CT scans, 6 (29%) had IH at operation versus 15 (71%) who were negative. The sensitivity of CT scan to detect an internal hernia is 76% with 95% confidence interval (CI) [53% to 90%] and specificity is 60% with 95% CI [39% to 78%]. Sensitivity increased to 96% with 95% CI [78% to 99.8%] when combining CT scans with neutrophilia findings. CONCLUSION: Positive CT scans are sensitive for IH but not specific. CT scans will not detect IH in 1:4 patients; despite negative findings, surgical exploration should remain the gold standard for patients with acute abdominal pain after LRYGB or biliopancreatic diversion when IH is a consideration.
BACKGROUND: While surgical exploration remains the gold standard for diagnosing internal hernia (IH) after certain bariatric surgeries, decisions for operative intervention are often based on computed tomography (CT) findings. OBJECTIVES: The aim of this study is to review our institutional experience and create an algorithm to approach patients presenting with abdominal pain and/or emesis after certain bariatric procedures. SETTINGS: University Hospital METHODS: Following institutional review board approval, a retrospective chart review of all patients presenting with obstruction symptoms after laparoscopic Roux-en-Y gastric bypass (LRYGB) was performed at 2 institutions from 2008 to 2013. Patients without CT scans or with incidental hernia defect findings were excluded. CT and intraoperative findings were compared via univariate statistical analysis. RESULTS: Fifty-two patients who underwent an operation for a suspected IH were identified. Of the 50 patients, 25 (50%) had IH at operation. Twenty-nine patients (58%) had positive CT scans read for IH and/or obstruction. Of these 29, 19 (66%) were found to have IH at operation and 10 (34%) underwent negative diagnostic laparoscopy. Of the 21 patients with negative CT scans, 6 (29%) had IH at operation versus 15 (71%) who were negative. The sensitivity of CT scan to detect an internal hernia is 76% with 95% confidence interval (CI) [53% to 90%] and specificity is 60% with 95% CI [39% to 78%]. Sensitivity increased to 96% with 95% CI [78% to 99.8%] when combining CT scans with neutrophilia findings. CONCLUSION: Positive CT scans are sensitive for IH but not specific. CT scans will not detect IH in 1:4 patients; despite negative findings, surgical exploration should remain the gold standard for patients with acute abdominal pain after LRYGB or biliopancreatic diversion when IH is a consideration.
Authors: Jeannette C Ederveen; Marijn M G van Berckel; Saskia Jol; Simon W Nienhuijs; Joost Nederend Journal: Eur Radiol Date: 2018-03-02 Impact factor: 5.315
Authors: Belinda De Simone; Elie Chouillard; Almino C Ramos; Gianfranco Donatelli; Tadeja Pintar; Rahul Gupta; Federica Renzi; Kamal Mahawar; Brijesh Madhok; Stefano Maccatrozzo; Fikri M Abu-Zidan; Ernest E Moore; Dieter G Weber; Federico Coccolini; Salomone Di Saverio; Andrew Kirkpatrick; Vishal G Shelat; Francesco Amico; Emmanouil Pikoulis; Marco Ceresoli; Joseph M Galante; Imtiaz Wani; Nicola De' Angelis; Andreas Hecker; Gabriele Sganga; Edward Tan; Zsolt J Balogh; Miklosh Bala; Raul Coimbra; Dimitrios Damaskos; Luca Ansaloni; Massimo Sartelli; Nikolaos Parasas; Yoram Kluger; Elias Chahine; Vanni Agnoletti; Gustavo Fraga; Walter L Biffl; Fausto Catena Journal: World J Emerg Surg Date: 2022-09-27 Impact factor: 8.165