Internal hernia due to gastric bypass surgery

Dr Henry Knipe and Dr Bruno Di Muzio et al.

Internal hernias due to gastric bypass surgery are more common after laparoscopic gastric bypass than after an open procedure. 

Incidence after a Roux-en-Y gastric bypass may range between 1-16%. The presence of strangulation may be associated with a mortality rate exceeding 50% ref.  

It is a particularly sinister complication with variable, non-specific clinical presentations. Most patients report a combination of postprandial abdominal pain, nausea and emesis 1. Patients may present at any time after surgery, however the majority are delayed, occurring after more than a month 2.

Physical examination findings are likewise non-specific, and may range from vague abdominal tenderness to palpation to peritonism ref

It has been suggested that patients are more prone to internal hernias after laparoscopic Roux-en-Y gastric bypass than after an open operation because there are fewer adhesions to tether small-bowel loops and prevent them from herniating. In addition, patients who have greater degrees of weight loss after laparoscopic Roux-en-Y gastric bypass may be more prone to internal hernia because of loss of the protective, space-occupying effect of mesenteric fat 1

Laparoscopic Roux-en-Y gastric bypass surgery produces three potential sites for internal hernia formation: 

  • at the defect in the transverse mesocolon through which the Roux limb passes (if it is placed in the retrocolic position)
  • at the mesenteric defect at the enteroenterostomy
  • behind the Roux limb mesentery placed in a retrocolic or antecolic position (retrocolic Petersen and antecolic Petersen type) 1

Postoperative complications which may present similarly after re-routing procedures include :

Article information

rID: 14022
Synonyms or Alternate Spellings:
  • Internal hernias due to gastric bypass surgery

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Cases and figures

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