Abstract
Background
Internal hernia (IH) is one of the more acute and potentially devastating complications after laparoscopic gastric bypass (LGB). Currently, there is no way to predict which patients will develop IH. We propose that patients who undergo periods of rapid excess weight loss (EWL) following LGB are more likely to develop IH.
Methods
A retrospective review of a prospectively collected laparoscopic gastric bypass database from our bariatric center was performed. Patient data between 2002 and 2009 was reviewed. Demographics, initial body mass index (BMI), detailed weight loss curves, and morbidity, specifically IH, were reviewed. Statistical analysis was performed. Logistic regression analysis was used to obtain an adjusted odds ratio for rapid weight loss and hernia development.
Results
We reviewed all 934 LGB procedures performed. The average initial BMI was 49.1 kg/m2 (range = 34–91 kg/m2). EWL based on our current averages at 1, 3, 6, 9, and 12 months postoperatively were 20, 40, 60, 75, and 85%. We statistically defined rapid EWL as greater than the 90th percentile for weight loss. Rapid EWL was noted in 33.2% (310/934) of patients. Fifty-eight (6.2%) patients were identified with IH. Of these, 27(46.5%) had periods of rapid EWL (odds ratio [OR] = 1.83; 95% CI = 1.07, 3.02). Bivariate analysis of patient factors that led to rapid EWL identified initial BMI (49.3 vs. 46.6 kg/m2) and rapid EWL as increasing the likelihood of developing IH (p = 0.026). A multivariate logistic model for IH identified only rapid EWL as a predictive factor. Locations of IH were the jejunojejunostomy (24), Pedersen’s defect (23), adhesions (9), and colonic mesentery (1). There were five patients with combined JJ and Pederson’s hernias.
Conclusion
Outcomes from missed IH can be catastrophic. In our large, single-center series, we have found that patients who undergo periods of rapid EWL are at nearly twice the risk for development of IH as the rest of the gastric bypass population.
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References
Carmody B, DeMaria EJ, Jamal M, Johnson J, Carbonell A, Kellum J, Maher J (2005) Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 1(6):543–548
Champion JK, Williams M (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13(4):596–600
Cho M, Pinto D, Carrodeguas L, Lascano C, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP, Zundel N, Szomstein S, Rosenthal RJ (2006) Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases. Surg Obes Relat Dis 2(2):87–91
Eckhauser A, Torquati A, Youssef Y, Kaiser JL, Richards WO (2006) Internal hernia: postoperative complication of Roux-en-Y gastric bypass surgery. Am Surg 72(7):581–584
Garza E, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T (2004) Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg 188(6):796–800
Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment, and prevention. Obes Surg 13(3):350–354
Ianelli A, Facchiano E, Gugenheim J (2006) Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 16(10):1265–1271
Paroz A, Calmes JM, Giusti V, Suter M (2006) Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg 16(11):1482–1487
Rogula T, Yenumula PR, Schauer PR (2007) A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc 21(11):1914–1918
Madan AK, Lo Menzo E, Dhawan N, Tichansky DS (2009) Internal hernias and nonclosure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass. Obes Surg 19(5):549–552
Coleman MH, Awad ZT, Pomp A, Gagner M (2006) Laparoscopic closure of the Petersen mesenteric defect. Obes Surg 16(6):770–772
Hwang RF, Swartz DE, Felix EL (2004) Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 18(11):1631–1635
Disclosures
William Cobb receives educational support, is a consultant for, and is on the speaker’s bureau for WL Gore. He is on the speaker’s bureau at Ethicon Inc. and receives educational support from and is a consultant for Ethicon EndoSurgery. He is also on the speaker’s bureau and is a consultant for Covidien. John Scott is an advisor for WL Gore and receives grant support from Ethicon EndoSurgery. Alfredo Carbonell is a speaker and consultant for and receives grant support from WL Gore, is a consultant and advisory board member for Ethicon Inc., receives grant support from Ethicon EndoSurgery, and is a consultant for Kensey Nash. Eric Bour receives fellowship funding from and is a speaker for Ethicon Endosurgery and is a speaker for WL Gore. Christopher Schneider and Katie Myers have no conflicts of interest or financial ties to disclose.
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Schneider, C., Cobb, W., Scott, J. et al. Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc 25, 1594–1598 (2011). https://doi.org/10.1007/s00464-010-1444-9
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DOI: https://doi.org/10.1007/s00464-010-1444-9