Internal hernias due to gastric bypass surgery

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

Types

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
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Article Information

rID: 14022
Section: Gamuts
Synonyms or Alternate Spellings:

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