Ransford Commey, MD, Ryan Lehmann, DO, FACS, FASMBS, Norbert Richardson, MD, FACS, FASMBS. St Alexius Hospital
Background: Following laparoscopic gastric bypass, internal hernia can occur at Petersen’s space and at the jejunojejunostomy mesenteric defect, which can lead to potentially serious complications, and as such, must be promptly diagnosed and treated. Port site hernia is a long term complication of laparoscopy. The risk factors for hernia formation include age, wound infection, smoking, trocar site, trocar size and obesity. Port site hernia is increased with incisions greater than 10mm in diameter. In the RYGB with circular stapled gastrojejunostomy, the left lower quadrant port site is at greatest risk for hernia since it is dilated to accommodate the anvil and circular stapler.
Methods: We present the case of a 54-year-old obese female with a body mass index of 36.8 who is status post Lap-band revision to laparoscopic Roux-en-Y divided gastric bypass who presented with complaints of one week of epigastric pain radiating to the left upper quadrant. She underwent a contrast computed tomography scan which showed a less than 1 cm bowel-containing ventral/incisional hernia. She was subsequently taken to the operating room for laparoscopic exploration with planned open repair of the hernia. On exploration, she was additionally found to have an internal hernia with strangulated small bowel at Petersen’s space which was reduced and repaired. The incisional hernia, which appeared to be intramuscular, was also repaired in an open fashion using mesh.
Results: The video shows the evaluation of the port site hernia, beginning with laparoscopic exploration with reduction and repair of the incidentally found strangulated internal hernia at Petersen’s space. The incisional hernia was then repaired in an open fashion.
Conclusion: Laparoscopic Exploration for Internal Hernias is the best practice during any return to OR for abdominal pain after laparoscopic gastric bypass. A missed diagnosis of internal hernia may cause potentially serious complications resulting from acute strangulation of the intestine.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87137
Program Number: V194
Presentation Session: Wednesday Video Loop (Non CME)
Presentation Type: VideoLoop
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