Rodolfo J Oviedo1,2,3,4*
1Department of General Surgery, Texas Bariatric Specialists, USA
2Metropolitan Methodist Hospital, USA
3Southwest General Hospital, USA
4South Texas Surgical Institute, USA
Background: Reduction and closure of internal hernia has become a frequent emergency bariatric procedure at high-volume centers to treat complications after primary and revisional bariatric surgery. Methods: A retrospective chart review with IRB approval was conducted on 61 emergency bariatric surgery cases performed by a single surgeon at an accredited MBSAQIP high-volume bariatric center and community hospital from August 2018 to February 2020. A subgroup analysis of 34 internal hernia repairs after a prior primary or revisional bariatric operation was conducted with measurement of primary outcomes (30-day morbidity and mortality) and secondary outcomes (concomitant adhesiolysis and small bowel resection, length of stay, recurrence and need for reoperation, among others). Results: All patients (n=34) underwent an emergency repair of internal hernia after prior primary or revised Roux en Y gastric bypass (91.2%) and classic duodenal switch (8.8%). Most of them were female (85.3%), and the mean age was 49.3 ± 12.9 years. Almost all surgeries (97.1%) started laparoscopically, with a rate of conversion to open of 14.7%. There was no mortality, and the 30-day morbidity was 29.4%. The mean follow-up duration was 5.8 ± 5.4 months, and the median ASA class was 3. Adhesiolysis was performed in 76.5% of cases, while the rate of concomitant small bowel resection was 8.8%. A subsequent repair of internal hernia was performed in 26.5% of cases. Among the gastric bypass internal hernias, the most common configuration was retrocolic-retrogastric (61.8%), with a jejunojejunostomy mesenteric defect being the most common site of herniation (55.9%). A CT abdomen/pelvis was obtained in 100% of cases to make a definitive diagnosis, and all patients were taken to operating room within 4 hours of presentation. Conclusion: Emergency repair of internal hernia can be safely performed at a high-volume center and community hospital environment with the laparoscopic approach and with no mortality, although the 30-day morbidity can be significant. A prior Roux en Y gastric bypass is the most common indication, with the retrocolic-retrogastric anatomy and the jejunojejunostomy mesenteric defect as the most frequent configuration and site, respectively.
Oviedo RJ. Internal Hernia Repair as an Emergency after Primary and Revisional Bariatric Surgery: Results from a High-Volume Referral Center. Clin Surg. 2020; 5: 2861..