INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

 

The internal hernias after a Laparoscopic Gastric Bypass may occur in 10 % of patients.  Early detection is important because they threaten the patient by causing intestinal obstruction, intestinal strangulation with perforation and peritonitis.

It is very important to know that the Internal hernias often pass unnoticed delaying the diagnosis and the treatment. 

The doctors either do not suspect the problem as a cause of the symptoms or the patients misunderstand the severity of their symptoms due to their initially vague clinical symptoms.

It is very common that the patients tend self medicate themselves delaying the prompt attention, not consulting with a doctor until symptoms are more serious with a higher risk of catastrophic complications.

Internal hernias in patients with Gastric Bypass occur most frequently 18 months after surgery, however there are reports from the first postoperative day up to 25 years after the operation.

It is important to know if your doctor completed a laparoscopic Gastric Bypassretro colic” or gastric Bypass “ante colic”.

There are 3 sites in the first case (retro colic) where hernia occurs: At the Petersen’s space, at level the jejunum-jejunostomy and at the mesocolon underneath the transverse colon; and there are two sites in the ante colic laparoscopic Gastric Bypass with a potential internal hernia presentation.

When a surgeon uses sutures during the bypass surgery the potential of a hernia space decrease the risk of the presentation of internal hernia.

In some private hospitals operatory time is very expensive and some doctors prefer to ignore this very important surgical step, on the other hand, to close these spaces also requires the development of advanced laparoscopic skills to do it correctly and in expeditious manner with intracorporeal stitches to close such potential hernia spaces and that has to be done by hand (not staplers), as a result, that explains some of the incidence of hernia with intestinal obstruction.

Common symptoms of internal hernia after a Laparoscopic Gastric Bypass are mild peri umbilical pain progressing to an intermittently cramping pain but increases in frequency and if not treated it will progress to the classic intestinal obstruction.

Occasionally the intestinal obstruction is mild and resolves quickly but may become a true surgical emergency where the life of the patient is at risk and surgical laparoscopic treatment has to be done without delay.

If you experience any of the described symptoms you must act quickly to resolve the hernia and need to be explore the area by laparoscopic means.  Closure of the hernia ring is very feasible in most cases, even more, when a bypass patient arrives with obstruction and it is diagnosed quickly needs to undergoing laparoscopic exploration to avoid complications.  If not treated immediately the chances increase due to the high possibility of a second catastrophic event.

Don’t expect that the hernia will be resolved with general measures because sooner or later the patient’s life is in jeopardy.

Dr. Arturo Rodriguez

Gastric Surgery and Obesity

http://www.thebariatric.com

http://www.bandstersforum.com

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8 Responses to “INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS”

  1. kris says:

    I had my band put on about 9 years ago and had great success. I went from 230 to 130 and maintained that weight until two years ago. I had a baby and eeven at 7 months pregnanat i weighed 136. I then had the fluid out of my band for the rest of my pregnancy. I have had a few fills since then, but I can”t seem to get under 180. Not sure if there are anythings I shouls be doing different or if there are any suggestions. Would really love to get back down to pre-pregnancy size. thanks, Kris

  2. Hello Kris,
    Grat to hear you did great and you will again soon.
    Do you have the same amount of restriction now then before pregnancy? Have you been checked under fluoro?
    You need to increase your daily activity and look for a proteinic diet rather a “normal” diet.
    Let me know.

  3. dariann says:

    I had the rygb 5 yrs ago….a few yrs ago I started having sharp abdominal pain lasting a few minutes. It would happen a every few months…i asked my dr. and was told it was a fat deposit…then it happened again a few weeks ago which lasted a few days and still sore…i was then told that it was a lypoma…..im concerned thats its an internal hernia but they want to rule everything else out…i had a upper and lower scope done….lower came back negative but they think I have a wheat allergen…..im at my wit ends…any suggestions????

  4. Hi Dariann,
    It is very common that doctors miss the internal hernia diagnosis specially if they are not surgeons familiar to the RNYGB surgery and complications.
    It is also very important to know if the RYGB was done posteriorly or anteriorly in relation to the colon and also where the pain is located.
    Plain abdominal X Rays while you are on pain are very useful and also an abdominal tomography.

  5. Colleen says:

    I had RNYGB surgery in November 2010 Recently I have been experiencing colicky cramps in abdomen left side I also get constipated & assume it’s why I’m in pain Now I think it may be an Internal Hernia should I call my surgeon? Not sure what to do

  6. Hi Colleen,
    It is a good time to be checked again by your surgeon and to be sure that you don’t have an internal hernia after a Gastric Bypass.

  7. Allison says:

    My boyfriend had gastric bypass about a year ago and just went in this week for emergency surgery to remove scar tissue wrapped around his bowels and repair a small tear. He is now out riding a motorcycle 3 days after surgery is this safe? What are his odds of having complications if he does lift things over 15 lbs in the next 3 weeks?

  8. Hi Allison,
    I think he will be fine specially if he had a laparoscopic revisión.

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