An Expanded Retrospective Review of Trocar Site Hernias in Laparoscopic Gastric Bypass Patients
Journal of Laparoendoscopic&Advanced Surgical Techniques , Vol. 0, No. 0.
Morbid obesity is associated with an increased rate of hiatal and paraesophageal hernias (PEH). Concomitant repair at the time of Roux-En-Y gastric bypass is technically feasible, safe, and lowers recurrence rates; however, the ideal operative management remains controversial. The use of reinforcing mesh may further lower recurrence rates in the bariatric patient population. The patient is a 49 year-old female with a history of morbid obesity (BMI 42) and long-standing reflux with dysphagia. Preoperative endoscopy was notable for esophagitis and a moderate-sized PEH.
Internal hernias (IH) are a common complication after gastric bypass (GB). They can occur in 1-15% of patients and can happen at anytime after surgery. They can be life threatening and present acutely or chronic and present with vague symptoms. The treatment in all cases is surgical. This video highlights the laparoscopic approach to IH and technical tips that are helpful for reducing and treating these dangerous events. We use 2 patients to illustrate the basic surgical techniques. The first patient presented with IH 3 years after a sleeve gastrectomy conversion to GB.
Gastric bypass(GB) can present with internal hernias after surgery, especially at the jejujejunostomy defect. The defect is commonly closed with permanent suture. Permanent suture can cause problems such as stitch abscesses even after long periods. Herein we describe a case of a mesenteric abscess caused by a permanent braided suture that was used to close the defect of the jejujejunostomy. Case Description: The patient is a 39 year old female who underwent a antecolic antegastric laparoscopic GB.
Internal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) in the LRYGB remains controversial to prevent IH.
CONCLUSION: The closure of MDs eliminated the risk of IH in half of the operated patients of LRYGB in this series. PMID: 31521564 [PubMed - as supplied by publisher]
Internal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) to prevent IH in the LRYGB remains controversial.
Bariatric surgery has become of the most effective solutions for sustained weight loss in the world . Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common procedures for treatment of morbid obesity. Females are more likely to undergo a bariatric procedure for weight loss. While significant and sustained weight loss is the primary advantage to bariatric surgery, other positive outcomes include improved fertility in women . This improved fertility can increase the chances of pregnancy.
CONCLUSIONS: Based on abdominal pain characteristics, we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernia) in many patients after antecolic RYGB, only occasionally complicating. Therapeutic management of these cases remains controversial, being laparoscopic exploration a reasonable option when symptomatology is suggestive. PMID: 31125004 [PubMed - in process]
ConclusionTransjejunal LAERCP is a feasible technique to deal with choledocholithiasis, and it allows at the same time to identify and treat concomitant conditions like internal hernias.
ConclusionSynchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.