Learning objectives
- To illustrate the CT findings of internal hernias (IH) in patients undergone to laparoscopic Roux-en-Y gastric bypass (LRYGB).
- To focus on the importance of postsurgical anatomy to make an accurate diagnosis.
Background
LRYGB is one of the most commonly performed surgical procedures worldwide for morbid obesity,
considered by many the gold standard.
This is due to its durable clinical outcomes in terms of excess weight loss and other comorbidities compared to other bariatric procedures.
Postoperative IH still remains to be an important cause of morbidity in these patients (0-5%).
Its formation is summarized in Fig. 1.
IH clinical diagnosis can result challenging. It usually appears as a late complication,
presenting variably from acute to chronic intermittent abdominal...
Findings and procedure details
Computed tomography (CT) remains the imaging modality of choice for diagnosing IH.
The LRYGB is a procedure which modifies the gastrointestinal tract anatomy,
making its recognition troublesome sometimes and implying a considerable interobserver variability.For that reason,
holding a heightened awareness and understanding of the altered anatomy and the typical CT signs of IH are important to prevent a diagnosis delay with subsequent increase morbidity and mortality.
A)LRYGB MODIFIED ANATOMY
The LRYGB consists of creating two limbs.
The first oneimplies thegastric pouch,which is the lesser gastric...
Conclusion
- Internal hernias are a well-known complication of LRYGB and a diagnostic challenge.
-A proper knowledge of the postsurgical anatomy and the indirect signs on CT are important to make a prompt diagnosis.
References
-Ahmed,
A.,
Rickards,
G.,
Husain,
S.,
Johnson,
J.,
Boss,
T.
and O’Malley,
W.
(2007).
Trends in Internal Hernia Incidence After Laparoscopic Roux-en-Y Gastric Bypass.Obesity Surgery,
17(12),
pp.1563-1566.
-Chowbey,
P.,
Baijal,
M.,
Kantharia,
N.,
Khullar,
R.,
Sharma,
A.
and Soni,
V.
(2016).
Mesenteric Defect Closure Decreases the Incidence of Internal Hernias Following Laparoscopic Roux-En-Y Gastric Bypass: a Retrospective Cohort Study.Obesity Surgery,
26(9),
pp.2029-2034.
-Geubbels,
N.,
Lijftogt,
N.,
Fiocco,
M.,
van Leersum,
N.,
Wouters,
M.
and de Brauw,
L.
(2015).
Meta-analysis of internal herniation after gastric bypass...