title: Internal hernia as a complication of laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Internal hernia (IH) is a well known complication of Roux-en-Y gastric bypass (RYGBP) which is more frequently encountered when the RYGBP is done laparoscopically.
  
  
  METHODS
  Patients with IH were identified from a prospective data-base of morbidly obese patients undergoing bariatric surgery at our center.
  
  
  RESULTS
  10 patients with IH were identified out of 625 patients undergoing LRYGBP from 1998 to 2006 (incidence 1.6 %). The defects were closed in the last 155 cases with non-absorbable running sutures. There were 8 women and 2 men with mean age 38 years (range 28-54). The mean interval of time elapsed between LRYGBP and clinical presentation of IH was 26.5 months (range 7 days - 72 months). Abdominal pain, nausea and vomiting were the most common complaints. White blood cell count was increased to a mean of 64 mg/dl (range 45-155 mg/dl) in 6 patients. CT scan showed signs of intestinal obstruction in all 7 patients with acute presentation. Surgery was done by laparoscopy in 5 cases (2 in the setting of emergency), and by laparotomy in the remaining 5 cases. All IHs were located at the mesenteric defect and were treated with IH reduction in all but one patient who underwent small bowel resection. There was no mortality, and one patient had pneumonia with acute respiratory distress syndrome that resolved favorably.
  
  
  CONCLUSIONS
  IH after LRYGBP occurred mainly at the mesenteric defect and in patients with no closure of the defect. The antecolic approach for the Roux-limb, the division of the greater omentum only when too thick, and the systematic closure of the defects with tight non-absorbable running sutures are recommended.
authors.affiliation: Université de Nice-Sophia-Antipolis, Faculté de Médecine, Nice, F-06107, France. antonio_iannelli@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.forename: Massimo Senni
authors.initials: MS
authors.lastname: Buratti
authors.forename: Sebastian
authors.initials: S
authors.lastname: Novellas
authors.forename: Moucef
authors.initials: M
authors.lastname: Dahman
authors.forename: Imed Ben
authors.initials: IB
authors.lastname: Amor
authors.forename: Eric
authors.initials: E
authors.lastname: Sejor
authors.forename: Enrico
authors.initials: E
authors.lastname: Facchiano
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D046449:Hernia, Abdominal / Q000209:etiology*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012189:Retrospective Studies