Imed Ben Amor1, Radwan Kassir2, Tarek Debs1, Saud Aldeghaither3, Niccolo Petrucciani4, Marco Nunziante5, Patrick Baqué6, Abdullah Almunifi1, Jean Gugenheim1. 1. Department of Digestive Surgery and Center of Bariatric Surgery and Center of Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France. 2. Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. radwankassir42@hotmail.Fr. 3. Department of General Surgery, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia. 4. Department of Digestive Surgery, Hôpital Henri-Mondor (APHP), Paris, France. 5. Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. 6. Department of General Surgery, University of Nice-Sophia-Antipolis, Nice, France.
Abstract
BACKGROUND: Internal hernia is a rare but a potentially fatal complication of laparoscopic Roux-En-Y gastric bypass (LRYGB). The aims of this study are to determine the impact of mesenteric defects closure on the incidence of internal hernia after LRYGB and to determine the symptoms, characteristics, and management of internal hernias after LRYGB. METHODS: A retrospective study for a total of 2093 LRYGB was carried out from 1998 to December 2013. Four hundred twenty-one patients were operated without closure of the mesenteric defects (group A). From January 2005 to December 2013, 1672 patients were operated with closure of the mesenteric defects at Petersen defect (PD) and at jejunojejunal anastomosis (J-J) defect (group B). The incidence of internal hernias was compared between the two periods. RESULTS: Out of the 2093 patients who underwent LRYGB, 20 patients (0.95%) developed a symptomatic internal hernia that required primary surgical intervention; 7 patients (1.66%) in group A all at J-J DEFECT versus 13 patients (0.78%) in (group B) 6 at (J-J DEFECT), 5 at PD, and 2 at PD, J-J DEFECT. This incidence was significantly lower in (group B) (p = 0.0021). The median interval between LRYGB and reoperation was 53 months in group A and 26 months in group B. A CT scan was performed in 8 patients, 40%, and showed signs of occlusion in all cases. CONCLUSIONS: The closure of mesenteric defects during LRYGB is recommended because it is associated with a significant reduction in the incidence of internal hernia.
BACKGROUND:Internal hernia is a rare but a potentially fatal complication of laparoscopic Roux-En-Y gastric bypass (LRYGB). The aims of this study are to determine the impact of mesenteric defects closure on the incidence of internal hernia after LRYGB and to determine the symptoms, characteristics, and management of internal hernias after LRYGB. METHODS: A retrospective study for a total of 2093 LRYGB was carried out from 1998 to December 2013. Four hundred twenty-one patients were operated without closure of the mesenteric defects (group A). From January 2005 to December 2013, 1672 patients were operated with closure of the mesenteric defects at Petersen defect (PD) and at jejunojejunal anastomosis (J-J) defect (group B). The incidence of internal hernias was compared between the two periods. RESULTS: Out of the 2093 patients who underwent LRYGB, 20 patients (0.95%) developed a symptomatic internal hernia that required primary surgical intervention; 7 patients (1.66%) in group A all at J-J DEFECT versus 13 patients (0.78%) in (group B) 6 at (J-J DEFECT), 5 at PD, and 2 at PD, J-J DEFECT. This incidence was significantly lower in (group B) (p = 0.0021). The median interval between LRYGB and reoperation was 53 months in group A and 26 months in group B. A CT scan was performed in 8 patients, 40%, and showed signs of occlusion in all cases. CONCLUSIONS: The closure of mesenteric defects during LRYGB is recommended because it is associated with a significant reduction in the incidence of internal hernia.
Authors: Nestor de la Cruz-Muñoz; Juan C Cabrera; Melissa Cuesta; Scott Hartnett; Renan Rojas Journal: Surg Obes Relat Dis Date: 2010-10-16 Impact factor: 4.734
Authors: Romano Schneider; Michaela Schulenburg; Marko Kraljević; Jennifer M Klasen; Thomas Peters; Bettina Wölnerhanssen; Ralph Peterli Journal: Langenbecks Arch Surg Date: 2021-05-22 Impact factor: 3.445