Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a relatively high incidence of internal hernias (IH) when compared to the open operation.


METHODS
A search in PubMed MEDLINE from January 1994 through January 2006 was performed (keywords: obesity, laparoscopy, gastric bypass and internal hernia).


RESULTS
26 studies with a total of 11,918 patients were considered. 300 cases of IH occurred (rate 2.51%). IH occurred 116 times at the level of the transverse colon mesentery (69%), 30 at the Petersen's space (18%), and 22 at the entero-enterostomy site (13%). 142 re-operations were performed laparoscopically (85.6%), and 24 by laparotomy (14.4%). Bowel resection was done in 5 cases (4.7%). Mortality was 1.17%.


CONCLUSIONS
IH after LRYGBP has an incidence of 2.51%. Closure of mesenteric defects with non-absorbable running suture and antecolic Roux limb are recommended. Surgical exploration for suspicion of IH after LRYGBP should be first done by laparoscopy.
Iannelli
Antonio
A
Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet, Nice, France. antonio_iannelli@hotmail.com
Facchiano
Enrico
E
Gugenheim
Jean
J
D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006547:Hernia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D013536:Suture Techniques