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 Bypass “retro 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.
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