title: Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects.
abstract: BACKGROUND
  Bowel obstruction due to internal hernia is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRGB). Increasing evidence supports primary closing of the mesenteric defects, but controversy continues about surgical technique of systematic closure. This paper reviews our experience with internal hernia after LRGB and describes a new method of preemptive closure of the mesenteric defects.
  
  
  METHODS
  Two thousand four hundred seventy-two consecutive patients undergoing LRGB from September 2005 to June 2010 were entered into our prospective longitudinal database. The mesenteric defects were not closed. Patients entered a 5-year follow-up program, and all who subsequently presented with internal hernia were analyzed. A further 1,630 patients operated on in the last 12 months were subjected to our new technique of closing the defects; data were entered in our own database as well as in the Scandinavian quality registry. Follow-up time for these patients is limited.
  
  
  RESULTS
  In the first group, 117 patients developed an internal hernia (4.7%) at a mean interval after LRGB of 13 (range, 4-43 months). Four patients needed bowel resections because of severe ischemia. There was one death associated with complication of the internal hernia. In the primary closure group, four patients early in the series had reoperations for kinking of the enteroanastomosis. There have been no mesenteric haematomas encountered.
  
  
  CONCLUSIONS
  Internal hernia should be ruled out in patients with previous LRGB and abdominal pain. Our technique for primary closing of the mesenteric defects seems to be safe and is so far promising.
authors: Department of Surgery, Aleris Hospital, Fredrik-Stangsgt. 11-13, 0264, Oslo, Norway. Ebrahim.Aghajani@aleris.no
authors: Ebrahim
authors: E
authors: Aghajani
authors: Hedin J
authors: HJ
authors: Jacobsen
authors: Bent Johnny
authors: BJ
authors: Nergaard
authors: Jan L
authors: JL
authors: Hedenbro
authors: Björn Geir
authors: BG
authors: Leifson
authors: Hjörtur
authors: H
authors: Gislason
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult