title: Laparoscopic Management of Internal Hernia After Roux-en-Y Gastric Bypass.
abstract: Internal hernia (IH) represents the most common cause of small-bowel obstruction after laparoscopic RYGBP. The anatomic changes resulting from RYGBP, the use of laparoscopy, and the postoperative weight loss all account for the high incidence of IH after this procedure. As the symptoms may be very vague, the interpretation of the clinical picture may result difficult. Moreover, laparoscopic treatment of IH could be very challenging for surgeons not familiar with the modified intestinal anatomy of the RYGBP.
  
  
  
  The video shows the management of an IH at the Petersen's defect. A 51-year-old female was assessed for recurrent abdominal pain 3 years after a RYGBP. A CT scan showed the mesenteric swirl sign, so a diagnostic laparoscopy was performed. The video first shows the identification of the herniated bowel through the mesenteric defect. Then, complete reduction of the IH and the closure of the Petersen's defect are shown.
  
  
  
  The total operative time was 35 min. The postoperative stay was uneventful and the patient was discharged in postoperative day one.
  
  
  
  In case of clinical suspicion of IH, even in case of normal laboratory and radiological findings, a surgical exploration is indicated.
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy. enricofacchiano@yahoo.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Facchiano
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Leuratti
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Veltri
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Quartararo
authors.affiliation: Centre Hospitalier Universitaire of Nice, Digestive Center, Nice, F-06202, Cedex 3, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, C3M, Team 8, "Hepatic Complications in Obesity", Nice, F-06204, Cedex 3, France.|University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice, F-06107, Cedex 2, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Lucchese
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D008643:Mesentery / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D014057:Tomography, X-Ray Computed
keywords: Bariatric surgery; Complication; Internal hernia; Intestinal obstruction; Laparoscopy; Obesity; Roux-en-Y gastric bypass