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Long-Term Follow-up and Risk of Recurrence of Internal Herniation after Roux-en-Y Gastric Bypass

Zaigham, Hassan LU orcid ; Ekelund, Mikael LU and Regnér, Sara LU orcid (2023) In Obesity Surgery 33(8). p.2311-2316
Abstract

Purpose: Internal herniation (IH) is the most common complication after Roux-en-Y gastric bypass surgery (RYGB). Although primary closure has reduced the incidence, recurrences are a continued problem. This study aimed to investigate long-term follow-up and recurrence risk of IH surgery. Methods: A retrospective cohort study of laparoscopic RYGB operated patients operated for a first IH between April 2012 and April 2015 at Skåne University Hospital in Malmö, Sweden. Status of primary closure of mesenteric gaps, time since RYGB, and findings at IH surgery were retrieved from medical records. Follow-up until December 31st, 2019, included recurrences of IH, number of computed tomography (CT) scans, emergency visits, readmissions, and other... (More)

Purpose: Internal herniation (IH) is the most common complication after Roux-en-Y gastric bypass surgery (RYGB). Although primary closure has reduced the incidence, recurrences are a continued problem. This study aimed to investigate long-term follow-up and recurrence risk of IH surgery. Methods: A retrospective cohort study of laparoscopic RYGB operated patients operated for a first IH between April 2012 and April 2015 at Skåne University Hospital in Malmö, Sweden. Status of primary closure of mesenteric gaps, time since RYGB, and findings at IH surgery were retrieved from medical records. Follow-up until December 31st, 2019, included recurrences of IH, number of computed tomography (CT) scans, emergency visits, readmissions, and other acute surgeries. Results: IH (n = 44) occurred almost equally in Petersen’s space (n = 24) and beneath the jejunojejunostomy (n = 20). Long-term follow-up (median 75 months) of 43 patients registered an IH recurrence rate of 14% (n = 6). All recurrences occurred in the other mesenteric gap. One patient suffered a third IH, and one patient had four IH events. During follow-up, 56% (n = 24) had ER visits for abdominal pain, 47% (n = 20) had ≥ 1 abdominal CT scan, and 40% (n = 17) were readmitted. A third of readmitted (6/17) patients suffered a recurrence of internal herniation. Two other patients were readmitted ≥ 10 times for chronic abdominal pain. Conclusion: Surgery for IH had a low risk of recurrence at the treated mesenteric gap, but a 14% recurrence risk at the other mesenteric gap, emphasizing the importance of carefully investigating weaknesses or gaps at the other mesenteric defect during surgery for IH. Graphical Abstract: [Figure not available: see fulltext.]

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Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Abdominal surgery, Bariatric surgery, Gastric bypass, Hernia, Internal hernia, Treatment outcome
in
Obesity Surgery
volume
33
issue
8
pages
6 pages
publisher
Springer
external identifiers
  • pmid:37266865
  • scopus:85160845687
ISSN
0960-8923
DOI
10.1007/s11695-023-06653-9
language
English
LU publication?
yes
id
7a5d5c21-8433-4501-a879-a8df69d9d34a
date added to LUP
2023-08-24 15:01:26
date last changed
2024-04-20 01:37:23
@article{7a5d5c21-8433-4501-a879-a8df69d9d34a,
  abstract     = {{<p>Purpose: Internal herniation (IH) is the most common complication after Roux-en-Y gastric bypass surgery (RYGB). Although primary closure has reduced the incidence, recurrences are a continued problem. This study aimed to investigate long-term follow-up and recurrence risk of IH surgery. Methods: A retrospective cohort study of laparoscopic RYGB operated patients operated for a first IH between April 2012 and April 2015 at Skåne University Hospital in Malmö, Sweden. Status of primary closure of mesenteric gaps, time since RYGB, and findings at IH surgery were retrieved from medical records. Follow-up until December 31st, 2019, included recurrences of IH, number of computed tomography (CT) scans, emergency visits, readmissions, and other acute surgeries. Results: IH (n = 44) occurred almost equally in Petersen’s space (n = 24) and beneath the jejunojejunostomy (n = 20). Long-term follow-up (median 75 months) of 43 patients registered an IH recurrence rate of 14% (n = 6). All recurrences occurred in the other mesenteric gap. One patient suffered a third IH, and one patient had four IH events. During follow-up, 56% (n = 24) had ER visits for abdominal pain, 47% (n = 20) had ≥ 1 abdominal CT scan, and 40% (n = 17) were readmitted. A third of readmitted (6/17) patients suffered a recurrence of internal herniation. Two other patients were readmitted ≥ 10 times for chronic abdominal pain. Conclusion: Surgery for IH had a low risk of recurrence at the treated mesenteric gap, but a 14% recurrence risk at the other mesenteric gap, emphasizing the importance of carefully investigating weaknesses or gaps at the other mesenteric defect during surgery for IH. Graphical Abstract: [Figure not available: see fulltext.]</p>}},
  author       = {{Zaigham, Hassan and Ekelund, Mikael and Regnér, Sara}},
  issn         = {{0960-8923}},
  keywords     = {{Abdominal surgery; Bariatric surgery; Gastric bypass; Hernia; Internal hernia; Treatment outcome}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{2311--2316}},
  publisher    = {{Springer}},
  series       = {{Obesity Surgery}},
  title        = {{Long-Term Follow-up and Risk of Recurrence of Internal Herniation after Roux-en-Y Gastric Bypass}},
  url          = {{http://dx.doi.org/10.1007/s11695-023-06653-9}},
  doi          = {{10.1007/s11695-023-06653-9}},
  volume       = {{33}},
  year         = {{2023}},
}