Abdullah Almunifi1, Imed Ben Amor, PhD2, Saud Aldeghaither21, Tarek Debs2, Niccolo Petrucciani2, Jean Gugenheim, PhD2. 1Department of General Surgery at College of medicine at Majmaah University, Al Majma’ah, Saudi Arabia., 2Service of Digestive Surgery and Center of Bariatric Surgery and center of Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
Objective: The internal hernia is a rare but a potentially fatal complication of Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). The aims of this study are 1- To determine the impact of mesenteric defects closure on the incidence of internal hernia after (LRYGB). 2- To determine the symptoms, characteristics and Managements of internal hernia after (LRYGB).
Methods: A retrospective study for a total of 2093 (LRYGB) which has been done Since 1998 till December 2013 at Nice University Hospital “L’Archet 2“ Department of Digestive surgery and liver transplantation center.
Till December 2004, 421 patients were operated without closing of mesenteric defects (Group A). From January 2005 until December 2013, 1672 patients were operated with closing mesenteric defects at Petersen’s Defect (PD) and at level of jejuno-jejunal anastomosis (JJA), by tight non-absorbable continued sutures (Group B). The incidence of internal Hernia was compared between two periods.
Results: From 2093 patients who underwent LRYGB, 20 patients (0.95 %) developed a symptomatic internal hernia that required primary surgical intervention, 7 patients (1.66 %) in (Group A) all at (JJA) versus 13 patients (0.78 %) in (Group B) 6 at (JJA), 5 at (PD) and 2 at (PD, JJA), This incidence was significantly lower in (Group B) (P= 0.0021). The median interval between (LRYGB) and reoperation is 53 months in group A and 26 months in group B. The median percentage of excess weight loss (%EWL) is 61% vs 67%, respectively (p= 0.79). 14 patients 70% (5 in group A) were admitted in an emergency with an acute abdomen pain. CT scan was performed in 8 patients 40 % and has shown signs of occlusion in all cases. The most common symptoms were abdominal pain and vomiting. The surgery was performed by laparoscopy in 8 patients 40% and by laparotomy or conversion in 12 patients 60%. In all cases internal hernia was reduced and closed all defects. In only one patient in (group A) small bowel at JJA was resected. There was no mortality and one patient had pneumonia with acute respiratory distress which was treated medically.
Conclusions: The closure of mesenteric defects at (LRYGB) by tight non-absorbable continued sutures is recommended because it is associated with a significant reduction in the incidence of internal hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87321
Program Number: P564
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster