Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) has been shown to be a safe and effective alternative to traditional
“open” RYGBP. Although lack of postoperative adhesions is one advantage of minim
ally invasive surgery, this is also responsible
for a higher incidence of internal hernias. These patients often present with intermittent abdominal pain or small bowel obstruction
with completely normal contrast radiographs. Methods: Data was obtained concurrently on 2,000 consecutive patients from February
1998 to October 2001 and analyzed retrospectively. Radiographs, when available, were interpreted by both the operative surgeon
and radiologist before intervention. Results: 66 internal hernias occurred in 63 patients, an incidence of 3.1%. 1 patient
presented with a traditional adhesive band and small bowel obstruction. 20% of patients had normal preoperative small bowel
series and/or CT scans. The site of internal hernias varied: 44 – mesocolon; 14 – jejunal mesentery; 5 – Petersen’s space.
Although most patients were symptomatic, 5% were incidental findings at the time of another surgical procedure. 5 patients
required open repair. 6 patients presented with perforation either at the time of diagnosis or as a result of manipulation
of the bowel. There was 1 death associated with complications of the internal hernia. The negative exploration rate was 2%.
Conclusion: Internal hernias are more common following laparoscopic RYGBP than “open” RYGBP. Contrast radiographs alone are
unreliable in ruling out this diagnosis. Early intervention is crucial; most repairs can be performed laparoscopically. This
diagnosis should be entertained in all patients with unexplained abdominal pain following laparoscopic RYGBP. Meticulous closure
of all potential internal hernia sites is essential to limit this potentially lethal complication.