title: Internal Hernia in Pregnant Women After Gastric Bypass: a Retrospective Register-Based Cohort Study.
abstract: OBJECTIVE
  Pregnant women who have previously had laparoscopic Roux-en-Y gastric bypass surgery are increasingly seen in the acute surgical care setting with abdominal pain due to internal hernia. With this study, we want to contribute with our experience and to present our local surgical guidelines concerning this particularly vulnerable patient group.
  
  
  METHODS
  This article is a retrospective study on prospectively collected data. Using data from the Danish National Health Register, we identified 23 women who had bariatric surgery previously and who were admitted to our surgical department and operated on for suspicion of internal hernia. Additional data was collected from patient files and surgical files.
  
  
  RESULTS
  We identified 23 women who all during pregnancy underwent surgery on suspicion of internal hernia; in 17 patients, the diagnosis was confirmed. We found that laparoscopic approach in our sample was performed as late as the 31st gestational week. All women and foetuses survived this dangerous condition, and none suffered from serious complications, nor did any of the patients have a bowel resection due to small bowel strangulation.
  
  
  CONCLUSIONS
  In skilled clinical hands, internal hernia has a good prognosis in pregnant patients. Surgery may be performed subacutely or even electively, depending on the condition of patient and foetus, and straightforward clinical assessment is adequate, and imaging studies, e.g. CT, are not necessary.
authors.affiliation: Department of Surgery, Hvidovre University Hospital, Kettegård, Allé 30, DK 2650, Hvidovre, Denmark. charlottegudbrand@hotmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gudbrand
authors.affiliation: Department of Surgery, Hvidovre University Hospital, Kettegård, Allé 30, DK 2650, Hvidovre, Denmark. lisbethandreasen@me.com.
authors.forename: Lisbeth Anita
authors.initials: LA
authors.lastname: Andreasen
authors.affiliation: Department of Surgery, Hvidovre University Hospital, Kettegård, Allé 30, DK 2650, Hvidovre, Denmark. a.boile@dadlnet.dk.
authors.forename: Astrid Elisabeth
authors.initials: AE
authors.lastname: Boilesen
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; Gastric bypass; Internal hernia; Pregnancy