Internal Hernia: Postoperative Complication of Roux-en-Y Gastric Bypass Surgery

2006 ◽  
Vol 72 (7) ◽  
pp. 581-585 ◽  
Author(s):  
Aaron Eckhauser ◽  
Alfonso Torquati ◽  
Yassar Youssef ◽  
Joan L. Kaiser ◽  
William O. Richards
Keyword(s):  
Gastric Bypass ◽  
Length Of Stay ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
The United States ◽  
Morbidity And Mortality ◽  
Transverse Mesocolon ◽  
Surgical Morbidity ◽  
Internal Hernias ◽  
Clinical Awareness

Obesity surgery is becoming one of the most common general surgery procedures done in the United States. Internal hernias are a known and increasingly more common occurrence after laparoscopic roux-en-Y gastric bypass (LRYGB). Increased clinical awareness of this complication will lead to decreased surgical morbidity and mortality. We retrospectively reviewed our database of 529 patients who had undergone LRYGB from 2000 to 2005 and identified those presenting with intestinal obstruction from an internal hernia. The type of internal hernia (jejunojejunostomy, transverse mesocolon, roux limb mesentery [Peterson's hernia]), length of time from presentation to operative intervention, and length of stay were obtained for all patients. Of 529 laparoscopic retrocolic retrogastric LRYGBs, 13 internal hernias (2.5%) were identified in 13 different patients. Eight of the hernias were at the mesenteric defect created by the jejunojejunostomy (62%), 3 originated from the transverse mesocolon defect (23%), and 2 were a Peterson's hernia (15%). The median time from initial operation to repair was 150 days. The average time from presentation to operative repair was 29.2 hours (range, 5–67.5 hours). The median length of stay was 3 days (range, 1.5–45 days). Eleven hernias were repaired laparoscopically (85%). There were no mortalities associated with obstruction from the internal hernia. Intestinal obstruction from an internal hernia after LRYGB is becoming increasingly more common. General awareness of this condition and high clinical suspicion allow for prompt surgical intervention with decreased morbidity and mortality.

scholarly journals FIXING JEJUNAL MANEUVER TO PREVENT PETERSEN HERNIA IN GASTRIC BYPASS

2015 ◽  
Vol 28 (suppl 1) ◽  
pp. 69-72 ◽  
Author(s):  
Abdon José MURAD-JUNIOR ◽  
Christian Lamar SCHEIBE ◽  
Giuliano Peixoto CAMPELO ◽  
Roclides Castro de LIMA ◽  
Lucianne Maria Moraes Rêgo Pereira MURAD ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Internal Hernia ◽  
Intraoperative Complications ◽  
Transverse Mesocolon ◽  
Internal Hernias ◽  
Hernia Formation ◽  
Elective Laparoscopic Cholecystectomy ◽  
The Right ◽  
Interesting Alternative

Background : Among Roux-en-Y gastric bypass complications is the occurrence of intestinal obstruction by the appearance of internal hernias, which may occur in Petersen space or the opening in mesenteric enteroenteroanastomosis. Aim : To evaluate the efficiency and safety in performing a fixing jejunal maneuver in the transverse mesocolon to prevent internal hernia formation in Petersen space. Method : Two surgical points between the jejunum and the transverse mesocolon, being 5 cm and 10 cm from duodenojejunal angle are made. In all patients was left Petersen space open and closing the opening of the mesenteric enteroenteroanastomosis. Results : Among 52 operated patients, 35 were women (67.3%). The age ranged 18-63 years, mean 39.2 years. BMI ranged from 35 to 56 kg/m2 (mean 40.5 kg/m2). Mean follow-up was 15.1 months (12-18 months). The operative time ranged from 68-138 min. There were no intraoperative complications, and there were no major postoperative complications and no reoperations. The hospital stay ranged from 2-3 days. During the follow-up, no one patient developed suspect clinical presentation of internal hernia. Follow-up in nine patients (17.3%) showed asymptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy. During these procedures were verified the Petersen space and jejunal fixation. In all nine, there was no herniation of the jejunum to the right side in Petersen space. Conclusion : The fixation of the first part of the jejunum to left side of the transverse mesocolon is safe and effective to prevent internal Petersen hernia in RYGB postoperatively in the short and medium term. It may be interesting alternative to closing the Petersen space.

scholarly journals Internal hernia through dual defects: defects in transverse mesocolon and lesser omentum a rare presentation: case report

2021 ◽  
Vol 9 (1) ◽  
pp. 236
Author(s):  
Venu Bharagava Malpuri ◽  
Prasanth Gurijala ◽  
Bhaskar Reddy Yerrola ◽  
Krishna Ramavath ◽  
Gopisingh Lavudya
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Morbidity And Mortality ◽  
Transverse Mesocolon ◽  
Hernia Sac ◽  
Internal Hernias ◽  
Contrast Enhanced Ct ◽  
Asymptomatic Patients

Internal hernias have the potential to cause small bowel obstruction. Congenital internal hernias are impossible to diagnose clinically and radiologically in asymptomatic patients. We presented a case of 36 years male with complaints of pain abdomen abdominal distension and vomiting, contrast-enhanced CT showed an internal hernia with small bowel obstruction. On exploration, small bowel loops were identified near the lesser curvature and they are congested an edema was present, a defect of 5×1 cm was identified in the transverse mesocolon and was managed by reducing the hernia sac and closure of the defect in the mesentery of the transverse colon. If the intervention was delayed internal hernia might lead to ischemia, gangrene increasing morbidity and mortality. Early intervention is the key to decrease morbidity and mortality. 

scholarly journals Internal Incarceration of Left Paraduodenal Hernia with Necrosis of Proximal Jejunum and Atypical Reconstruction of the Passage: A Case Report

2013 ◽  
Vol 6 (2) ◽  
pp. 139-142
Author(s):  
Pentcho T. Tonchev ◽  
Sergei D. Iliev ◽  
Ivailo M. Presolski
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Proximal Portion ◽  
Paraduodenal Hernia ◽  
Proximal Jejunum ◽  
Radiological Findings ◽  
Transverse Mesocolon ◽  
Internal Hernias ◽  
Purulent Peritonitis

Summary Internal hernias are rare and most of them are diagnosed intraoperatively. We present a case of a 53-year-old man with proximal intestinal obstruction, caused by incarcerated internal hernia. During the operation, a proximal portion of 40 cm of the jejunum was found herniated and strangulated in the lesser sac through an opening of the transverse mesocolon. The jejunum was necrotic and local purulent peritonitis was present. After resection of the proximal 40 cm of the jejunum, the passage was restored using an unconventional approach. The distal duodenum was closed and, to protect the stump, the duodenum was ligated between its second and third parts. A latero-lateral anastomosis was made between the first part of duodenum and the jejunum. Anatomical, clinical and radiological findings, diagnosis and treatment of paraduodenal hernias are discussed in brief.

Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal

2019 ◽  
Vol 62 (6) ◽  
pp. 24-27
Author(s):  
Leslie M. Leyva Sotelo ◽  
José E. Telich Tarriba ◽  
Daniel Ángeles Gaspar ◽  
Osvaldo I. Guevara Valmaña ◽  
André Víctor Baldín ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Early Diagnosis ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Internal Hernia ◽  
Wide Spectrum ◽  
Internal Hernias ◽  
Mild Abdominal Pain ◽  
Made In

Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

scholarly journals Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report

2002 ◽  
Vol 120 (3) ◽  
pp. 84-86 ◽  
Author(s):  
Gustavo Gibin Duarte ◽  
Belchor Fontes ◽  
Renato Sérgio Poggetti ◽  
Marcos Roberto Loreto ◽  
Paulo Motta ◽  
...  
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Clinical Manifestations ◽  
Acute Intestinal Obstruction ◽  
Main Task ◽  
Intestinal Necrosis ◽  
Lesser Omentum ◽  
Lesser Sac ◽  
Internal Hernias

CONTEXT: Internal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare. CASE REPORT: We report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter. CONCLUSION: The early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case.

Use of Bioabsorbable Tissue Reinforcement Reduces Incidence of Internal Hernia in Roux-en-Y Gastric Bypass Patients

2018 ◽  
Vol 84 (11) ◽  
pp. 1756-1761
Author(s):  
Michael W. Love ◽  
Roosbeh Mansour ◽  
Allyson L. Hale ◽  
Eric S. Bour ◽  
Ihab Shenouda ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Soft Tissue ◽  
Internal Hernia ◽  
Tissue Scaffold ◽  
Internal Hernias ◽  
Early Evidence ◽  
Hernia Formation ◽  
Tissue Matrix ◽  
Tissue Defects ◽  
Prospective Database

Internal hernias are one of the most devastating late, postsurgical complications associated with laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to determine whether placement of a bioabsorbable tissue matrix in soft tissue defects after gastric bypass resulted in a lower incidence of internal hernia development. Prospective database was used to identify all patients who underwent LRYGB between January 2002 and January 2016. These patients were then retrospectively reviewed to determine the development of internal hernia. Before 2009, the retro-Roux defect was left open during the primary operation and the defect at the jejunojejunostomy was closed with sutures or staples. Beginning in 2009, all soft tissue internal defects were reinforced with an 8 cm 3 8-cm piece of bioabsorbable matrix. The incidence of subsequent internal hernia development was compared between these two groups: no bioabsorbable matrix versus use of a bioabsorbable matrix. A total of 2771 patients underwent LRYGB during our study period. From these, 1215 procedures were performed without tissue reinforcement and 1556 were performed using a bioabsorbable matrix. During the study period, 274 patients developed an internal hernia. Patients who did not have tissue reinforcement at closure had a significantly higher internal hernia rate [225/1215 (18.5%) vs 49/1556 (3.1%), P < 0.005]. This study demonstrates a statistically significant reduction in internal hernia formation after LRYGB with the addition of a bioabsorbable tissue matrix. Although prospective studies are needed, early evidence suggests that reinforcement with a bioabsorbable tissue scaffold is an effective method for minimizing internal hernias after LRYGB.

Varying Lymphadenectomies for Gastric Adenocarcinoma in the East Compared with the West: Effect on Outcomes

2012 ◽  
pp. 250-255
Author(s):  
Benjamin Schmidt ◽  
Sam S. Yoon
Keyword(s):  
The Netherlands ◽  
Gastric Adenocarcinoma ◽  
Survival Benefit ◽  
Locoregional Recurrence ◽  
The United States ◽  
Morbidity And Mortality ◽  
Surgical Approaches ◽  
Recurrence Rates ◽  
Surgical Morbidity ◽  
The United Kingdom

Overview: There are notable differences in surgical approaches to gastric adenocarcinoma throughout the world, particularly in terms of the extent of lymphadenectomy (LAD). In high-incidence countries such as Japan and South Korea, more extensive (e.g., D2) lymphadenectomies are standard, and these surgeries are generally done by experienced surgeons with low morbidity and mortality. In countries such as the United States, where the incidence of gastric adenocarcinoma is 10-fold lower, the majority of patients are treated at nonreferral centers with less extensive (e.g., D1 or D0) lymphadenectomy. There is little disagreement among gastric cancer (GC) experts that the minimum lymphadenectomy that should be performed for gastric adenocarcinoma should be at least a D1 lymphadenectomy, and many of these experts recommend a D2 lymphadenectomy. More extensive lymphadenectomies provide better staging of patient disease and likely reduce locoregional recurrence rates. Two large, prospective randomized trials performed in the United Kingdom and the Netherlands in the 1990s failed to demonstrate a survival benefit of D2 over D1 lymphadenectomy, but these trials have been criticized for inadequate surgical training and high surgical morbidity and mortality rates (10% to 13%) in the D2 group. More recent studies have demonstrated that Western surgeons can be trained to perform D2 lymphadenectomies on Western patients with low morbidity and mortality. The 15-year follow-up of the Netherlands trial now demonstrates an improved disease-specific survival and locoregional recurrence in the D2 group. Retrospective analyses and one prospective, randomized trial suggest that there may be a survival benefit to more extensive lymphadenectomies when performed safely, but this assertion requires further validation.

scholarly journals Inverted bladder diverticulum with sigmoid colon herniation masquerading as bowel and bladder obstruction

2018 ◽  
Vol 5 (11) ◽  
pp. 3767
Author(s):  
Pratima . ◽  
Abhilash . ◽  
Suma S ◽  
Krishna Prasad
Keyword(s):  
Intestinal Obstruction ◽  
Sigmoid Colon ◽  
Internal Hernia ◽  
Bladder Diverticulum ◽  
Surgical Experience ◽  
Bladder Obstruction ◽  
Internal Hernias ◽  
Abdominal Organs ◽  
Bladder Diverticula ◽  
Primary Bladder

Urinary bladder diverticula can be congenital or acquired, and the latter tends to occur in older men and results from urinary obstruction. Primary bladder diverticula are congenital, smooth walled, solitary in nature and rarely diagnosed in adults. An internal hernia (IH) is a protrusion of intestines or other abdominal organs through a normal or abnormal orifice in the peritoneum or mesentery, occasionally leading to strangulation or incarceration. Internal hernias (IH) are rare causes of acute abdomen and intestinal obstruction in adults. Here we present a case report detailing the authors' surgical experience with inverted bladder diverticulum, presenting as internal hernia with sigmoid colon herniating through it, with features of acute intestinal obstruction and urinary dysfunction.

scholarly journals LEFT PARA-DUODENAL HERNIA

2016 ◽  
Vol 23 (02) ◽  
pp. 238-240
Author(s):  
Asrar Ahmad ◽  
Irum Saleem ◽  
Nisar Ahmed ◽  
Farrukh Ayub
Keyword(s):  
Intestinal Obstruction ◽  
Internal Hernia ◽  
High Index ◽  
Paraduodenal Hernia ◽  
Internal Hernias ◽  
High Index Of Suspicion

Internal hernia is defined as herniation of viscera through a defect in themesentery or peritoneum. Internal hernias can cause intestinal obstruction. Paraduodenalhernias though a rare cause of intestinal obstruction, are more common on the left side. Thesehernias may cause strangulation and gangrene of the intestines so a high index of suspicion isrequired for diagnosis. Treatment is always surgical. We hereby report a case of acute intestinalobstruction due to left paraduodenal hernia.

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