Type:
Educational Exhibit
Keywords:
Hernia, Diagnostic procedure, CT, Abdomen
Authors:
M. Lozano Ros, J. R. Olalla Muñoz, E. Girela Baena, C. Botía González, I. CASES SUSARTE, I. M. González Moreno; Murcia/ES
DOI:
10.26044/ecr2019/C-2450
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 pain.
The clinical presentation will depend both on the persistence or transience of the bowel through the mesentery defect and the existence of strangulation.
Furthermore,
IH has even been reported to be the most frequent cause of small bowel obstruction (SBO) occurring after LRYGB.
The antecolic LRYGB procedure,
specially with closure of both the mesenteric and Petersen defects,
has the lowest incidence of IH with low risk of major complications.
However,
since there are no randomized trials comparing the two approaches yet,
the choice between an antecolic and a retrocolic Roux limb is left to the surgeon's choice.
This issue will be further analysed in the next section.