Journal Basic Info
- Impact Factor: 1.995**
- H-Index: 8
- ISSN: 2474-1647
- DOI: 10.25107/2474-1647
Major Scope
- General Surgery
- Urology
- Neurological Surgery
- Orthopaedic Surgery
- Endocrine Surgery
- Minimally Invasive Surgery
- Obstetrics Surgery
- Cardiovascular Surgery
Abstract
Citation: Clin Surg. 2020;5(1):2861.Research Article | Open Access
Internal Hernia Repair as an Emergency after Primary and Revisional Bariatric Surgery: Results from a High-Volume Referral Center
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
*Correspondance to: Rodolfo J Oviedo
PDF Full Text DOI: 10.25107/2474-1647.2861
Abstract
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.
Keywords
Cite the article
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..