Melissa L Desouza, MD1, Daniel Davila Bradley, MD2, Kevin M Reavis, MD, FACS2. 1Oregon Health and Science University, 2The Oregon Clinic, Division of Gastrointestinal and Minimally Invasive Surgery
Background: Internal hernia is the most common cause of small bowel obstruction following Roux-en-Y gastric bypass and may result in devastating loss of bowel. Presented here is a laparoscopic repair of strangulated internal hernia in a patient presenting with severe ischemia of nearly her entire small bowel.
Methods: A laparoscopic reduction of the herniated bowel and repair of jejunal and Petersen’s defects post-gastric bypass was performed. Focus is given to radiographic findings, strategic port placement, a distal to proximal reduction of the herniated small bowel, closure of the mesenteric defects, and endoscopic confirmation of Roux, biliopancreatic, and common channel patency.
Results: A successful laparoscopic repair was performed without need for resection and the patient was able to discharge within 12 hours of surgery.
Conclusions: Internal hernia can present at any time following gastric bypass. Clinical suspicion should prompt immediate radiographic evaluation and surgical intervention should proceed without delay using a distal to proximal exploration. Most importantly, early intervention promotes early recovery and minimizes risk of catastrophic bowel necrosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94738
Program Number: V045
Presentation Session: Bariatric I – Complications
Presentation Type: Video