Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass: a Correlation Between Radiological and Operative Findings

被引:35
作者
Goudsmedt, Francis [1 ]
Deylgat, Bert [1 ]
Coenegrachts, Kenneth [2 ]
Van de Moortele, Kris [2 ]
Dillemans, Bruno [1 ]
机构
[1] AZ Sint Jan Brugge Oostende, Dept Gen Surg, Brugge, Belgium
[2] AZ Sint Jan Brugge Oostende, Dept Radiol, Brugge, Belgium
关键词
Gastric bypass; Internal hernia; Complication; Obstruction; Radiology; Peterson; MESENTERIC CLOSURE; MORBID-OBESITY; SURGERY;
D O I
10.1007/s11695-014-1433-5
中图分类号
R61 [外科手术学];
学科分类号
摘要
Even though internal hernia (IH) after a laparoscopic Roux-en-Y gastric bypass (LRYGB) is a well-known entity for bariatric surgeons and radiologists, accurate diagnosis remains difficult. The aim of this study was to evaluate the sensitivity and specificity of ten different CT findings in patients with a proven internal hernia after a LRYGB. A retrospective analysis of all LRYGB patients who underwent an explorative laparoscopy for abdominal pain has been performed. Preoperative CT scans were individually reviewed by two radiologists specialized in abdominal CT imaging in a randomized blind way. These results were compared with the operative reports. Between 2004 and 2013, 7,328 patients underwent a LRYGB. One hundred sixty nine of these patients underwent an explorative laparoscopy for abdominal pain after a LRYGB, 131 of which had a preoperative CT scan. Of these 131 patients, 72 suffered from an IH. Fifty-nine patients had no IH and served as control group. Mesenteric swirl was the best predictor with for reader 1 a sensitivity of 68 % and specificity of 86 % and for reader 2 a sensitivity of 89 % and specificity of 63 %. Other signs had an even larger interobserver variability. A CT scan can help in confirming the diagnosis of an IH, especially if a mesenteric swirl is present. However, since the presented sensitivities are variable and do not reach 100 %, IH might be missed, implicating that a high index of suspicion with a low threshold for explorative laparoscopy/-tomy remains the cornerstone of appropriate treatment.
引用
收藏
页码:622 / 627
页数:6
相关论文
共 17 条
[1]   Retrospective analysis of abdominal pain in postoperative laparoscopic Roux-en-Y gastric bypass patients: is a simple algorithm the answer? [J].
Agaba, Emmanuel A. ;
Gentles, Charmaine V. ;
Shamseddeen, Hazem ;
Sasthakonar, Venketesh ;
Kandel, Anui ;
Gadelata, Dominick ;
Gellman, Larry .
SURGERY FOR OBESITY AND RELATED DISEASES, 2008, 4 (05) :587-593
[2]   Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass [J].
Ahmed, Ahmed R. ;
Rickards, Gretchen ;
Husain, Syed ;
Johnson, Joseph ;
Boss, Thad ;
O'Malley, William .
OBESITY SURGERY, 2007, 17 (12) :1563-1566
[3]   Radiological Findings in Symptomatic Internal Hernias After Laparoscopic Gastric Bypass [J].
Ahmed, Ahmed R. ;
Rickards, Gretchen ;
Johnson, Joseph ;
Boss, Thad ;
O'Malley, William .
OBESITY SURGERY, 2009, 19 (11) :1530-1535
[4]   Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: Clinical and imaging findings [J].
Blachar, A ;
Federle, MP ;
Pealer, KM ;
Ikramuddin, S ;
Schauer, PR .
RADIOLOGY, 2002, 223 (03) :625-632
[5]   Impact of complete mesenteric closure on small bowel obstruction and internal mesenteric hernia after laparoscopic Roux-en-Y gastric bypass [J].
Brolin, Robert E. ;
Kella, Venkata N. .
SURGERY FOR OBESITY AND RELATED DISEASES, 2013, 9 (06) :850-854
[6]   Metabolic/Bariatric Surgery Worldwide 2011 [J].
Buchwald, Henry ;
Oien, Danette M. .
OBESITY SURGERY, 2013, 23 (04) :427-436
[7]   Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass [J].
de la Cruz-Munoz, Nestor ;
Cabrera, Juan C. ;
Cuesta, Melissa ;
Hartnett, Scott ;
Rojas, Renan .
SURGERY FOR OBESITY AND RELATED DISEASES, 2011, 7 (02) :176-180
[8]   Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients [J].
Dillemans, Bruno ;
Sakran, Nasser ;
Van Cauwenberge, Sebastiaan ;
Sablon, Thibault ;
Defoort, Barbara ;
Van Dessel, Els ;
Akin, Faki ;
Moreels, Nathalie ;
Lambert, Sebastiaan ;
Mulier, Jan ;
Date, Ravindra ;
Vandelanotte, Michel ;
Feryn, Tom ;
Proot, Luc .
OBESITY SURGERY, 2009, 19 (10) :1355-1364
[9]   Fewer adhesions induced by laparoscopic surgery? [J].
Gutt, CN ;
Oniu, T ;
Schernmer, P ;
Mehrabi, A ;
Büchler, MW .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2004, 18 (06) :898-906
[10]   Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up [J].
Higa, Kelvin ;
Ho, Tienchin ;
Tercero, Francisco ;
Yunus, Tahir ;
Boone, Keith B. .
SURGERY FOR OBESITY AND RELATED DISEASES, 2011, 7 (04) :516-525