Internal hernias due to gastric bypass surgery are more common after laparoscopic gastric bypass than after an open procedure.
It is a particularly sinister complication with variable, nonspecific clinical presentations. Most patients report a combination of postprandial abdominal pain, nausea and emesis 1.
It has been suggested that patients are more prone to internal hernias after laparoscopic Roux-en-Y gastric bypass than after an open operation because there are fewer adhesions to tether small-bowel loops and prevent them from herniating. In addition, patients who have greater degrees of weight loss after laparoscopic Roux-en-Y gastric bypass may be more prone to internal hernia because of loss of the protective, space-occupying effect of mesenteric fat 1.
Laparoscopic Roux-en-Y gastric bypass surgery produces three potential sites for internal hernia formation:
- at the defect in the transverse mesocolon through which the Roux limb passes (if it is placed in the retrocolic position)
- at the mesenteric defect at the enteroenterostomy
- behind the Roux limb mesentery placed in a retrocolic or antecolic position (retrocolic Petersen and antecolic Petersen type) 1