• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Internal Hernia Following Roux-En-Y Gastric Bypass: Our Institution’s 5 Year Experience

Internal Hernia Following Roux-En-Y Gastric Bypass: Our Institution’s 5 Year Experience

Victoria Needham, MD1, Jazmin Juarez2, Diego Camacho, MD1. 1Montefiore Medical Center, 2Albert Einstein College of Medicine

INTRODUCTION: We investigated the incidence of internal hernia (IH) in patients undergoing abdominal exploration at any interval following Roux-en-Y gastric bypass.  Of patients found to have IH, we evaluated their clinical and radiographic presentations leading up to operative re-intervention, as well as the technical aspects of their initial bypass, in efforts to elucidate predictors of this bariatric morbidity.

METHODS: We used a single-institution database from 2013-2017 to conduct a review of 213 cases of abdominal exploration (diagnostic laparoscopy or exploratory laparotomy) in patients with a history of bariatric surgery.

RESULTS: 110 patients had a history of Roux-en-Y gastric bypass (11 open, 99 laparoscopic).  In this group, upon operative re-exploration, 29 patients (26.1%) were found to have IH via one of the defects created by the prior bypass surgery.  Of these, 15 underwent antecolic configuration of the roux limb and 11 underwent retrocolic configuration (3 unknown) at their index operation.  All patients presented with abdominal pain, while physical exams ranged from mild tenderness to peritonitis.  The mean white blood cell count at presentation was 9.4 (SD 3.4).  69% of patients had a CT scan with at least one finding concerning for internal hernia:  swirl sign (58.6%), mesenteric edema (41.4%), free fluid (20.1%) and jejunojejunostomy (JJ) to right of midline (17.2%).  5 patients (17.2%) had a definitive small bowel obstruction diagnosed on preoperative CT scan, defined as oral contrast cutoff at a transition point in the small bowel.  Of patients with an internal hernia with available operative records, 1 patient herniated through a JJ mesenteric defect not closed at initial operation, 6 via a closed JJ defect, 8 via an unclosed Petersen’s defect, 9 via a closed Petersen’s defect, and 3 via a transverse mesocolic defect.  All defect closure that was performed during initial bypass surgery was noted to be done using nonabsorbable polyester sutures.

CONCLUSIONS: In our population, IH was found in over a quarter of patients who underwent abdominal exploration following Roux-en-Y gastric bypass.  Abdominal pain and CT findings concerning for internal hernia appear to be valuable factors in predicting the presence of IH.  However physical exam, leukocytosis and complete bowel obstruction on CT appear to be less reliable as grounds for suspicion.  Closure of mesenteric defects did not appear to prevent IH, however further investigation is needed to determine the role of surgical technique in the risk of developing eventual IH.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93723

Program Number: P089

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

View this Poster

84

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals