Chronic Pain After Gastric Bypass: Another Argument to Support Mesenteric Windows Closure.

Chronic pain is frequent after Roux-en-Y gastric bypass (RYGB). Recurrent internal hernias (IHs) may be responsible for chronic abdominal pain. Physical examination and computed tomography are often inconclusive. This observational retrospective study describes 11 patients who underwent elective laparoscopy for post-RYGB chronic abdominal pain of undetermined etiology after noninvasive investigations and failure of conservative treatment. Open intermesenteric and/or Peterson spaces were found in all cases; IH was present in 6 cases. Nine patients were totally relieved from symptoms after mesenteric windows closure; substantial improvement was noted in the remaining 2 cases. Peterson space was found more likely to be responsible for chronic IH. In such selected patients, laparoscopic exploration and windows closure should be discussed. These findings add support to initial windows closure during RYGB.