A625 Internal hernia after gastric bypass: 2 difficult cases with operative pearls - Part 1
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.
AbstractBackgroundOAGB-MGB emerged as a standard procedure, albeit RYGB remains the most frequently performed gastric bypass. Comparative studies are scarce.MethodsProspectively collected data (July 2006 to November 2017) from a large sample size and adequate follow-up were analyzed using logistic regression and linear mixed models. Total weight loss (TWL) within the first 3 years was defined as primary outcome and duration of operation, perioperative, and late complications and comorbidity remission as secondary outcomes.ResultsThree hundred twenty-four OAGB-MGBs (age 42.51 ± 11.36 years, 74.69% females) presented ...
ConclusionA tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under superv...
ConclusionRecent high-level literature recommends the use of mesh repair (flat mesh) in all patients with hernia width ≥ 1 cm. This evidence is limited to the use of flat mesh through an open approach. While AHSQC surgeons do offer mesh repair in the majority of cases, this is most commonly using a mesh patch, and is selective towards larger hernias and obese patients. Further research is required to evaluat e the safety of mesh patches, and a mesh repair should be offered to a young non-obese healthy patient, as they benefit similarly from the use of mesh.
Duodenal Switch post-operative complications include small bowel obstruction and internal hernias. This video presentation discusses the common causes for small bowel obstruction, demonstrating single band adhesions, mesocolic internal hernia, and mesoenteric internal hernia, including clinical presentation, radiographic evaluation, reduction technique, and repair.
Roux-en-Y gastric bypass (RYGB) is increasingly performed due to its effectiveness for weight loss and improvements of medical comorbidities. Common complications of RYGB include anastomotic leaks and strictures, marginal ulcers, small bowel obstructions, and internal hernias. A rare complication after RYGB is intussusception, which has a prevalence between 0.07% and 0.6%. Intussusception typically occurs in a retrograde fashion at the jejunojejunostomy and can present with nonspecific or obstructive symptoms.
Paraesophageal and sliding-type hiatal hernias are extremely common in patients who suffer from obesity. Concomitant hernia repairs at the time of bariatric surgery have been reported in as high as 20% of all bariatric surgeries. Bioabsorbable tissue matrices have been used to bolster and enhance sutured paraoesophageal hernia defects and reduce local recurrences. To date there exists no large volume study assess outcomes of hiatus hernias repaired at the time of concomitant bariatric surgery, particularly with respect to the use of bioabsorbable tissue matrix.
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.
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.
We present a case series of late term hiatal hernias after gastric bypass, and discuss the common presentation and treatment.
We investigated the incidence of complications following Roux-En-Y gastric bypass (RNY-GBP), and factors that may better-predict the risk for abdominal exploration following bariatric surgery.