title: Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases.
abstract: BACKGROUND
  It is common practice to close mesenteric defects in abdominal surgery to prevent postoperative herniation and subsequent closed-loop obstruction. The aim of this study was to review our experience with antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGBP) without division of the small bowel mesentery or closure of potential mesenteric defects.
  
  
  METHODS
  Data for 1400 patients who underwent AA-LRYGBP between January 2001 and December 2004 was prospectively collected and retrospectively analyzed for the incidence of internal hernias. In all cases, an antecolic antegastric approach was performed without division of the small bowel mesentery or closure of potential hernia defects.
  
  
  RESULTS
  Three patients (0.2%) developed a symptomatic internal hernia. Two of these patients had a 200-cm-long Roux limb, and the other had a 100-cm-long Roux limb. All three patients exhibited mild symptoms of partial small bowel obstruction. In all three cases the internal hernia was clinically manifested more than 10 months after the original AA- LRYGBP. Exploration revealed that the hernia site was between the transverse colon and the mesentery of the alimentary limb at the level of the jejunojejunostomy (Petersen's defect) in all three cases. All three patients underwent successful laparoscopic revision, hernia reduction, and mesenteric defect closure.
  
  
  CONCLUSIONS
  AA-LRYGBP without division of the small bowel mesentery or closure of mesenteric defects does not result in an increased incidence of internal hernias. The laparoscopic approach for reexploration appears to be an effective and safe option.
authors.affiliation: The Bariatric Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
authors.forename: Minyoung
authors.initials: M
authors.lastname: Cho
authors.forename: David
authors.initials: D
authors.lastname: Pinto
authors.forename: Lester
authors.initials: L
authors.lastname: Carrodeguas
authors.forename: Charles
authors.initials: C
authors.lastname: Lascano
authors.forename: Flavia
authors.initials: F
authors.lastname: Soto
authors.forename: Oliver
authors.initials: O
authors.lastname: Whipple
authors.forename: Conrad
authors.initials: C
authors.lastname: Simpfendorfer
authors.forename: John Paul
authors.initials: JP
authors.lastname: Gonzalvo
authors.forename: Nathan
authors.initials: N
authors.lastname: Zundel
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007421:Intestine, Small; D010535:Laparoscopy; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies