Laparoscopic Method of Diagnosing an Internal Hernia:

Internal hernia is a frequent and potentially grave complication of a gastric bypass occuring with an incidence of 1.5-5%. If the Roux-limb is retrocolic and antegastric there are three mesenteric defects in which the small bowel can be engaged: the jejuno-jejunostomy mesenteric defect, the mesocolic defect, and the Petersen’s space. The potential gravity of internal hernias and the difficulty of a clinic or radiological diagnosis require an early diagnostic operation. This surgery is hard to perform laparoscopically because of the altered abdominal anatomy in this patients. The purpose of this video is to demonstrate an easy method for diagnosis and for identification of the internal hernias in patient who underwent retrocolic antegastric Roux-en-Y gastric bypass.

Method:

Diagnostic laparoscopies were performed on patients with retrocolic antegastric Roux-en-Y Gastric Bypass complaining of abdominal pain. Seven steps were followed: 1)identification of the passage of the Roux limb through the mesocolon, 2)examination and closure of the Petersen’s space 3)and of the mesocolic defect, 4)following the Roux-limb 5)and the small bowel to the jejuno-jejunostomy, 6)examination and closure of the jejuno-jejunostomy mesenteric defect, and 7)searching for another potential cause of abdominal pain.

Results:

The seven step method followed made possible a fairly easy identification of the mesenteric defects and internal hernias allowing its early correction.

Conclusion:

The method proposed in this video makes it easy to identify each limb of the jejunojejunostomy and the mesenteric defects, allowing identification and correction of internal hernias. This technique should be followed by bariatric surgeons in order to prevent further complications.