A625 Internal hernia after gastric bypass: 2 difficult cases with operative pearls - Part 1

Abstract

Internal hernias (IH) are a common complication after gastric bypass (GB). They can occur in 1-15% of patients and can happen at anytime after surgery. They can be life threatening and present acutely or chronic and present with vague symptoms. The treatment in all cases is surgical. This video highlights the laparoscopic approach to IH and technical tips that are helpful for reducing and treating these dangerous events. We use 2 patients to illustrate the basic surgical techniques. The first patient presented with IH 3 years after a sleeve gastrectomy conversion to GB. The emergency general surgeon did not recognize the IH on computed tomography (CT). Trocar placement is discussed, as is starting at the terminal ileum and moving proximally. The complex part of this case was pouch rotation. The second case was a GB patient 14 years after surgery with complete incarceration of almost the entire small bowel. The patient also had chylous ascites. There are 2 preoperative CTs that the emergency general surgeon ordered that show progression of her obstruction. Operative treatment is shown and tips on how to reduce a difficult IH are highlighted.