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.

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.

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 Recurrent internal hernias after Roux-en-Y gastric bypass: An observational study in 1219 patients over 20 years

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
Y Fringeli ◽  
R Steffen ◽  
U Kessler ◽  
J Zehetner
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Laparoscopic Group ◽  
Small Bowel Resection ◽  
Median Percentage ◽  
Internal Hernias ◽  
Mesenteric Defects ◽  
Time Of Operation

Abstract Objective Internal hernia (IH) represents a well-known complication and the major cause of bowel obstruction after Roux-en-Y gastric bypass (RYGB) for morbid obesity. With the worldwide rise of performed RYGB, IH will become more frequent in the coming years. Lots of studies already addressed this issue to prevent its occurrence and improve its management. The aim of this study is to assess incidence and patterns of recurrence of IH. Methods A retrospective single-centre analysis was performed of prospectively collected follow-up data from patients who underwent a RYGB between January 2000 and December 2017 and who developed IH thereafter. Follow-up data were reviewed until December 2020. Both open (51) and laparoscopic procedures (1168) were included. All RYGB were performed using the antecolic technique with routine closure of the Petersen’s space (PS) and the mesenteric defect beneath the jejunojejunostomy (JJ). Only open mesenteric defects with incarcerated small bowel at the time of operation were considered as IH. Results One hundred thirty four patients presented with IH and all events occurred in the laparoscopic group (11.5%). Among the 134 patients with IH, a recurrence was observed in 35 patients (26.1%) after a median time of 13 months (range, 0-124) since the first IH. Seven patients presented more than 2 episodes of IH, among them one patient with 7 episodes. The median weight loss between the first and the second episode of IH was 0.0kg (range, -11.5-19.0) and the median percentage of excess weight loss achieved since the RYGB at the occurrence of the second IH was 97.2% (range, 55.3-111.2). Location of IH was PS in 70 patients (52.2%) at the time of the first IH and in 23 patients (65.7%) at the time of the second IH. Recurrence of IH at the same location was more frequent at the PS (22.9%) than at the JJ (10.9%). Overall, 185 operations for IH were performed, among them 132 (71.4%) laparoscopically. Only once, a small bowel resection was mandatory (0.5%). Conclusion For patients with laparoscopic RYGB, internal hernias represent a potential complication over a lifetime and have to be suspected even years after the index operation. One quarter of patients will develop a recurrence of IH and Petersen’s space is mostly involved.

scholarly journals Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective

2020 ◽  
Vol 3 (S 01) ◽  
pp. S35-S48
Author(s):  
Argha Chatterjee ◽  
Rochita V. Ramanan ◽  
Sumit Mukhopadhyay
Keyword(s):  
Gastric Bypass ◽  
Acute Abdomen ◽  
Internal Hernia ◽  
Surgical Planning ◽  
Imaging Modality ◽  
Surgical Anatomy ◽  
Imaging Features ◽  
Internal Hernias ◽  
Abdominal Hernias ◽  
The Common

AbstractPostoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.

Pregnancy After Gastric Bypass Surgery and Internal Hernia Formation

2005 ◽  
Vol 105 (Supplement) ◽  
pp. 1195-1198 ◽  
Author(s):  
Nirupama Kakarla ◽  
Christine Dailey ◽  
Teresa Marino ◽  
Scott A. Shikora ◽  
David Chelmow
Keyword(s):  
Gastric Bypass ◽  
Internal Hernia ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Hernia Formation

scholarly journals Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique

2020 ◽  
Vol 47 (4) ◽  
pp. 347-353
Author(s):  
Emine Malkoc Sen ◽  
Kubra Ozdemir Yalcinsoy
Keyword(s):  
Recurrence Rate ◽  
Intraoperative Complications ◽  
Case Series ◽  
Lower Eyelid ◽  
New Technique ◽  
Before And After ◽  
A New Technique ◽  
The Right ◽  
Horizontal Eyelid Laxity

Background This study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity.Methods This case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate.Results This new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56–87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6–60 months). No intraoperative complications were observed. All patients’ symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring.Conclusions The approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

scholarly journals Beyond Belsey: complex laparoscopic hiatus and diaphragmatic hernia repair

2019 ◽  
Vol 101 (3) ◽  
pp. 162-167 ◽  
Author(s):  
D Zanotti ◽  
C Fiorani ◽  
A Botha
Keyword(s):  
Diaphragmatic Hernia ◽  
Hiatus Hernia ◽  
Intraoperative Complications ◽  
Gastric Volvulus ◽  
Laparoscopic Approach ◽  
Acute Presentation ◽  
Different Types ◽  
The Right ◽  
Diaphragmatic Hernia Repair

Background Diaphragmatic and hiatus hernias can cause mild chronic symptoms or have an acute presentation with gastric volvulus and obstruction. Elective or emergency surgery is indicated in symptomatic patients and nowadays is generally performed laparoscopically. Methods We report four different types of hernias: a giant hiatus hernia following a gastric pull-up for recurrent congenital diaphragmatic hernia; a Bochdalek hernia in a pregnant young woman; concomitant hiatus and Morgagni hernias; and a giant hiatus hernia occupying the right chest. All were approached laparoscopically, either electively or as an emergency. Results Surgery led to a resolution of symptoms in all the cases. We had no any intraoperative complications. Two patients developed minor postoperative complications (chest infection). No recurrences were found during a mean follow-up of 18 months. Conclusions Transabdominal laparoscopic approach is a safe and feasible approach to all cases of symptomatic hiatus and diaphragmatic hernia.

scholarly journals Transmesocolon internal hernia masking as simple sigmoid volvulus

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Han N Beh ◽  
Yuni F Ongso ◽  
David B Koong
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Large Bowel ◽  
Sigmoid Volvulus ◽  
Emergency Laparotomy ◽  
Transverse Mesocolon ◽  
Hartmann Procedure ◽  
Internal Hernias ◽  
Colonic Decompression

Abstract Transmesocolon internal hernias are very rare causes of bowel obstruction. Transmesenteric internal hernias normally associated with small bowel. It can be challenging to diagnose transmesocolon internal hernia hence we present a 93-year-old patient who was misdiagnosed with simple sigmoid volvulus on CT abdomen. She underwent endoscopic colonic decompression. Patient continued to deteriorate in the ward, and CT abdomen was repeated; it revealed the cause of the sigmoid volvulus was due to a defect through transverse mesocolon resulting in internal hernia. Patient was diagnosed with transmesocolic internal hernia with sigmoid volvulus. Patient underwent emergency laparotomy and Hartmann procedure. Transmesocolic internal hernia can be easily missed and needs to be considered when diagnosing patients with large bowel volvulus or obstruction.

Ex-vivo renal surgery and auto-transplantation for benign and malignant renal pathologies: our early evolving experience of three cases

2017 ◽  
Vol 11 (1) ◽  
pp. 27-32
Author(s):  
Muhammad Z Aslam ◽  
Tim Brown ◽  
Ali A Thwaini
Keyword(s):  
Partial Nephrectomy ◽  
Ex Vivo ◽  
Intraoperative Complications ◽  
Disease Recurrence ◽  
Laparoscopic Nephrectomy ◽  
Renal Surgery ◽  
Renal Functions ◽  
Doppler Signals ◽  
The Right

Objectives: We describe our experience of ex-vivo renal surgery and autotransplantation for complex renal pathologies. These cases were carried out in the urology and transplant departments between July 2015 and January 2016. Materials and methods: Case 1 was a 63-year-old man presenting with spontaneous bleed from a renal mass in a solitary functional right kidney. Case 2 was a 50-year-old man with bilateral renal tumours involving renal veins. Case 3 was a 50-year-old man with two previous failed right-sided pyeloplasties. Results: No intraoperative complications were encountered. Case 1 underwent laparoscopic nephrectomy, ex-vivo partial nephrectomy followed by autotransplantation. There was no disease recurrence after 6 months’ follow-up, with stable renal functions. Case 2 had bilateral open radical nephrectomies performed. On the right autotransplantation was performed after ex-vivo partial nephrectomy. On the left, a further procedure was abandoned after radical nephrectomy due to extensive disease involvement. Postoperatively, the patient became anuric with poor Doppler signals. Exploration suggested complete renal vein obstruction with infarction of the autotransplanted right kidney requiring nephrectomy. Disease recurrence at the native renal bed was found at 6 months’ follow-up. Case 3 had laparoscopic nephrectomy, ex-vivo pyeloplasty and autotransplantation was performed. At 12 months’ follow-up, the patient was asymptomatic with stable renal functions. Conclusions: Ex-vivo renal surgery is a viable option for complex renal conditions. However, appropriate patient selection is essential to achieve good outcomes.

scholarly journals A retrospective study of internal small bowel herniation following pelvic lymphadenectomy for gynecologic carcinomas

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuji Tanaka ◽  
Yusuke Shimizu ◽  
Ai Ikki ◽  
Kota Okamoto ◽  
Atsushi Fusegi ◽  
...  
Keyword(s):  
Open Surgery ◽  
Rare Complication ◽  
Pelvic Lymphadenectomy ◽  
Internal Hernias ◽  
Significant Difference ◽  
Laparoscopic Pelvic Lymphadenectomy ◽  
The Right ◽  
Prevention Methods ◽  
Bowel Herniation

AbstractAfter pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic lymphadenectomy (IBSPP) are a rare complication following PLA. To the best of our knowledge, only 12 IBSPP cases have been reported and clinical details on such hernias remain unknown. The aim of the study was to investigate the incident and etiology of IBSPP. 1313 patients who underwent open or laparoscopic pelvic lymphadenectomy were identified from our database. A retrospective review was performed. Mean follow-up period was 33.9 months. A total of 12 patients had IBSPP. Multivariate analysis of laparoscopic surgeries group as compared to open surgeries group, para-aortic lymphadenectomy rate, number of dissected lymph nodes by PLA, antiadhesive material use rate, and blood loss were lower in laparoscopic surgeries group: odd ratio (OR) = 0.13 [95% confidence interval (CI) 0.08–0.19], and OR = 0.70 [95% CI 0.50–0.99], OR = 0.17 [95% CI 0.10–0.28], OR = 0.93 [95% CI 0.92–0.94]. However, no significant difference was observed in the incidence of IBSPP between laparoscopic surgery (1.0%) and open surgery (0.8%). All IBSPP occurred in the right pelvic space. These findings may contribute to the development of prevention methods for this disease.

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