internal hernia after GBP, systematic closure of Peterson and jejunojejunostomy during the primary surgery is the ultimate treatment and prevention of internal hernia.

Wissam Fakih, MD. Al Seef hospital

ntroduction :Internal hernia is one of the serious complications after gastric by pass, it causes recurrent attacks of abdominal pain and if left untreated it can lead to small bowel necrosis snd gangrene. CTScan is the gold standard test for the diagnosis, although a normal study does not exclude the diagnosis. Systematic closure of potential spaces may eliminate completely the occurrence of internal hernia.

Objectives: morbidity and mortality of internal hernia after gastric by pass can reach 60% if left untreated and if small bowel strangulation occurs. Early diagnosis and appropriate management can eliminate this chance and cure the patient. Primary closure during the initial surgery is the routine in our practice.

Methods: retrospective study was based on 2187 cases of gastric by pass between august 2009 and august 2013,
Results: 468 cases were done without closure and the remaining with primary closure. Internal hernia occurred in about 12,6 % in the first group ( 58 cases) and 0% in the second group.
72% had CTScan chowing the internal hernia, with or without free fluid in the abdomen. None of the cases presented with bowel perforation or gangrene.

36 cases with peterson space hernia.
12 cases with jejuno-jejunostomy hernia.
3 cases where the small bowel herniated through both spaces.
5 cases presented in 3rd trimester and had internal hernia diagnosed with MRI.
Almost all patients were symptomatic.
Almost all of them had lymphatic obstruction at the mesentery site with or without chyloperitoneum.

Results: internal hernia is a fatal complication after gastric by pass if left untreated. The cornerstone of treatment is based on high index of suspicion with or without radiologic confirmation. In case of doubt, diagnostic laparoscopy in mandatory done on urgent or elective bases depending on the severity of symptoms upon presentation. Prevention of this complication is routine closure of potential spaces during the primary surgery.

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