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CC BY 4.0 · Surg J (N Y) 2024; 10(03): e31-e35
DOI: 10.1055/s-0044-1788065
Original Article

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

Abdulmenem Abualsel
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
,
Raja Nadeem 
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
,
Fatema Abdulkarim AL-Ahmed
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
,
Ebrahim Adel Almahmeed
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
,
Roshan George Varkey
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
,
Sameer Almobarak
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
,
Ajaz A. Wani 
1   Divison of General and Bariatric Surgery, Department of Surgical Specialties, King Hamad University Hospital, Al Sayh, Bahrain
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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.




Publication History

Received: 13 February 2024

Accepted: 10 June 2024

Article published online:
04 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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