Internal Hernia Post-Single Anastomosis Gastric Bypass: Case Series with Review of Literature

Abstract

Obesity is an emerging worldwide health care issue. It has a direct and indirect bearing on health-related outcomes. Rates of overweight and obesity have grown manifold in the past few decades globally. Once considered a problem of the affluent societies only, obesity is now dramatically on the rise in low- and middle-income countries also. Single anastomosis gastric bypass (SAGB) is one of the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy. Internal hernia (IH) after SAGB is a less recognized clinical entity. We hereby report our experience with four such cases under light of current available literature. Bariatric procedures are associated with some short- and long-term limitations. IHs are among one of the dreaded complications associated with some bariatric procedures with rates reaching up to 16% after classic Roux-en-Y gastric bypass. The incidence of IH post-SAGB is comparatively rare and is very less frequently reported. Symptoms of IH post-SAGB are quite nonspecific and depend on the time and extent of herniation. The symptoms can vary from benign intermittent colicky pain to severe intra-abdominal pain presenting as a surgical emergency. Routine physical examination and biochemical investigations are nonspecific and unreliable in evaluating those patients. Computed tomography (CT) with intravenous and oral contrast is the most common imaging modality used for preoperative evaluation of those symptoms. The CT findings can be unremarkable in patients having intermittent symptoms/herniation. Diagnostic laparoscopy is the cornerstone for diagnosis and management of patients having high suspicion of IH.

Keywords

single anastomosis gastric bypass - contrast-enhanced computerized tomography - Roux-en-Y gastric bypass - excess weight loss - internal hernia

Ethical Approval

All patients gave adequate written authorization for their enrollment in the study and adequate institutional approval was taken.

Publikationsverlauf

Eingereicht: 13. Februar 2024

Angenommen: 10. Juni 2024

Artikel online veröffentlicht:
04. Juli 2024

• References

• 1 al-Mannai A, Dickerson JW, Morgan JB, Khalfan H. Obesity in Bahraini adults. J R Soc Health 1996; 116 (01) 30-32 , 37–40
• 2 Blachar A, Federle MP. Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT MR 2002; 23 (02) 174-183
• 3 Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis 2011; 7 (04) 516-525
• 4 Chevallier JM, Arman GA, Guenzi M. et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg 2015; 25 (06) 951-958
• 5 Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg 2017; 27 (05) 1153-1167
• 6 Schneider C, Cobb W, Scott J, Carbonell A, Myers K, Bour E. Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc 2011; 25 (05) 1594-1598
• 7 Bauman RW, Pirrello JR. Internal hernia at Petersen's space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure–a single surgeon series of 1047 cases. Surg Obes Relat Dis 2009; 5 (05) 565-570
• 8 Brolin RE, Kella VN. Impact of complete mesenteric closure on small bowel obstruction and internal mesenteric hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2013; 9 (06) 850-854
• 9 Koppman JS, Li C, Gandsas A. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9,527 patients. J Am Coll Surg 2008; 206 (03) 571-584
• 10 Escalona A, Devaud N, Pérez G. et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis 2007; 3 (04) 423-427
• 11 Obeid A, McNeal S, Breland M, Stahl R, Clements RH, Grams J. Internal hernia after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg 2014; 18 (02) 250-255 , discussion 255–256
• 12 Lockhart ME, Tessler FN, Canon CL. et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol 2007; 188 (03) 745-750
• 13 Iannuccilli JD, Grand D, Murphy BL, Evangelista P, Roye GD, Mayo-Smith W. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol 2009; 64 (04) 373-380
• 14 Facchiano E, Iannelli A, Lucchese M. Internal hernia after mini-gastric bypass: myth or reality?. J Visc Surg 2016; 153 (03) 231-232
• 15 Petrucciani N, Martini F, Kassir R. et al. Internal hernia after one anastomosis gastric bypass (OAGB): lessons learned from a retrospective series of 3368 consecutive patients undergoing OAGB with a biliopancreatic limb of 150 cm. Obes Surg 2021; 31 (06) 2537-2544
• 16 Gandhi AD, Patel RA, Brolin RE. Elective laparoscopy for herald symptoms of mesenteric/internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009; 5 (02) 144-149 , discussion 149