Jessica S Koller Gorham, MD, Andrew J Lambour, MD, Olivia A Sacks, Ravinder Kang, MD, Thadeus L Trus, MD. Dartmouth Hitchcock Medical Center
Introduction: Up to 11% of patients experience internal hernia (IH) after laparoscopic Roux-en-Y gastric bypass (RYGB). Studies have shown that antecolic Roux limb orientation, and closure of the mesenteric defect reduce, but do not eliminate, the incidence of IH. We hypothesize that despite operative differences, IH occur more frequently in patients who experience significant weight loss. This study aims to determine whether those patients who present with IH following RYGB experience greater than 70% excess body weight loss (EBWL).
Methods: A retrospective chart of all patients who underwent IH repair following RYGB at our institution between Sept 2014 to Sept 2017 was performed. All applicable CPT codes to encompass IH repair were reviewed (n=412). 17 patients with IH repair after RYGB were identified.
Results: Of the 17 patients, 16 were female. The mean pre-RYGB weight was 279lbs (sd +/- 54.5), BMI 37.8kg/m2 (sd +/- 8.7). All procedures but one were performed in an antecolic configuration; the other retrocolic-antegastric. Fifteen cases were laparoscopic and two were open; nine had the jejunal mesenteric defect closed, eight did not. The average weight loss from the time of RYGBP to IH presentation was 91.82lbs (sd +/- 38.18) and %EBWL from RYGB to the nadir weight was 77% (sd +/-24). When evaluated by t-test, there was no statistical difference in BMI at the time of program initiation, RYGB, or IH presentation, as well as number of pounds lost, %EBWL, or time to IH presentation, when comparing patients for whom the mesenteric defect was closed or not. Average time from RYGB to IH presentation was 4.5 years (range 190-4655 days).
Conclusion: In our limited cohort of patients who have presented with internal hernia after RYGB, there was an average of 77% EBWL. This is greater than the average expected %EBWL at our institution and others, suggesting that IH may occur in patients with greater weight loss at a higher frequency. Mesenteric defect closure did not appear to have any influence in this limited cohort, suggesting that weight loss is a stronger factor in IH development. We plan a more extensive evaluation in a larger cohort of patients to determine if greater %EBWL is a predictor of IH formation in patients undergoing RYGB.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88175
Program Number: P580
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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