Background: Internal hernia is a known complication after gastric bypass, especially when performed laparoscopically. The aim of this study was to see when internal hernias occur in relation to weight loss and time course after surgery. Furthermore, we wish to examine the impact of Roux limb positioning ante- versus retrocolic and whether switching to running versus interrupted closure of the mesenteric defects created at surgery made any difference.
Methods: A retrospective chart review was performed of all patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) who developed symptomatic internal hernia requiring operative intervention between January 1, 2000 and September 15, 2006.
Results: Fifty-four internal hernias occurred in 2,572 patients, an incidence of 2.1%. The site of internal hernias varied: 25 (1%), transverse mesocolon; 22 (0.8%), enteroenterostomy; 7 (0.3%), Peterson's space. The mean time to intervention for an internal hernia repair was 413 +/- 46 days and average % excess body weight loss (%EBWL) in this period was 59 +/- 3.3. Subgroup analysis demonstrates internal hernia incidence to be 2 in 357 (0.6%) in antecolic Roux versus 52 in 2,215 (2.4%) in retrocolic Roux limb (odds ratio = 4, P < 0.05). Continuous closure versus interrupted stitching of mesenteric defects does not seem to alter the incidence of internal hernias.
Conclusion: This study demonstrates that the majority of internal hernias occur after a significant (>50%) EBWL. Furthermore, the antecolic approach is associated with a much reduced incidence of internal hernia.
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http://dx.doi.org/10.1007/s11695-007-9260-6 | DOI Listing |
BMC Surg
January 2025
Center for Obesity and Hernia Surgery, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Background: The management of a recurrent (symptomatic) hiatal hernia remains controversial. This study aimed to review the outcomes of patients who underwent recurrent repair of hiatal hernias.
Methods: Thirteen patients who underwent recurrent hiatal hernia repairs at our hospital between 2018 and 2024 were reviewed retrospectively.
Taiwan J Obstet Gynecol
January 2025
Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China; Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China. Electronic address:
Objective: To explore outcomes of fetuses with severe congenital diaphragmatic hernia (CDH) after fetal endoluminal tracheal occlusion (FETO) treatment.
Case Report: Fetuses diagnosed with severe CDH and taken FETO for intrauterine treatment from January 2020 to December 2023 were recruited. There was no significant difference in general conditions, as well as O/E LHR and measurements related to CDH (p > 0.
J Surg Case Rep
January 2025
NYU Langone Hospital - Long Island, 259 1st St, Mineola, NY 11501, United States.
Internal herniation through the foramen of Winslow (FoW) is a rare, life-threatening diagnosis. We present a case of intestinal obstruction due to herniation of the ileum, cecum, appendix, and ascending colon through the FoW. We reduced the herniation using a small colotomy and preserved the entirety of the bowel.
View Article and Find Full Text PDFCureus
January 2025
General Surgery, Womack Army Medical Center, Fort Liberty, USA.
This case report presents a unique clinical presentation of small bowel obstruction secondary to congenital partial malrotation of the gut in adults. Partial malrotation may have variable clinical presentations and this case highlights a constellation of patient history, radiographic signs, and operative findings leading to appropriate diagnosis and successful surgical management. A 56-year-old female patient presented with severe abdominal pain, nausea, and anorexia.
View Article and Find Full Text PDFACG Case Rep J
January 2025
Department of Gastroenterology, District of Columbia Veteran Affairs Medical Center, Washington, DC.
The rising prevalence of obesity has led to a substantial investment in the advancement of treatment options for the disease and its comorbid conditions including lifestyle, pharmacologic, and procedural interventions. In this study, we describe a patient with a history of Roux-en-Y gastric bypass who was diagnosed with ischemic jejunitis on upper endoscopy because of the development of an internal hernia, a known late complication of bariatric surgery. This case highlights the diagnostic utility of endoscopy in postgastric bypass complications and the need for safer alternatives to surgery that have the potential to achieve significant weight loss such as bariatric endoscopic therapies.
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