Laparoscopic internal hernia repair after mini gastric bypass
Epublication WebSurg.com, Dec 2013;13(12). URL: http://websurg.com/doi/vd01en4097
Laparoscopic Roux-en-Y gastric bypass (LGBP) has been shown to be an effective treatment for morbid obesity, both in terms of weight loss and improvement in multiple comorbidities. While the laparoscopic approach offers many advantages to patients in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, some complications of this operation continue to pose difficult clinical problems as the number of procedures performed increases. One such complication is internal hernia through one of the mesenteric defects, which can result in small bowel obstruction (SBO), ischemia, or infarction, and often requires emergency reoperation. Internal hernias is a significant clinical problem, since it is the most common cause of small bowel obstruction after LGBP. Retrospective reviews have found the incidence of SBO after LGBP to be between 1.8 and 9.7%. The creation of a potential space as a result of weight loss may also be a contributing factor in the etiology of internal hernias, which often present in a delayed fashion. In addition, the particular case of pregnancy (with the mass effect of an enlarging uterus) may predispose to this condition. An internal hernia can potentially occur through either two or three defects, depending on whether a retrocolic or antecolic technique is used for the Roux limb. Petersen’s defect is defined as the space between the Roux limb and the transverse mesocolon. A defect is also present between the biliopancreatic and Roux limbs at the jejunojejunostomy. If a retrocolic approach is used, a third defect in the transverse mesocolon is created. This is the most common site of internal hernia in most reports, which has prompted many surgeons to adopt an antecolic technique in order to rule out this defect.