Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass

Abstract

BackgroundInternal hernia rate after Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is variable (0.5%–9%). MethodsWe retrospectively reviewed all patients who underwent diagnostic laparoscopy for possible internal hernia after RYGB from 2009 to 2016. All internal hernia defects were closed. ResultsWe performed 574 RYGB cases between 2013 and 2016, 33 diagnostic laparoscopies were performed (6 after RYGB done at our institution & 27 after RYGB done at outside institutions). Diagnostic laparoscopies after RYGB done at our institution showed internal hernia in 3/6 (50%), none at Petersen space, none had incarcerated small bowel or were converted to open. While 20/27 (74%) of diagnostic laparoscopies after RYGB done at outside institutions had an internal hernia, 18/20 (90%) at Petersen space, 15/27 (55%) had incarcerated small bowel and 3.7% needed small bowel resection or were converted to open. Our internal hernia rate after RYGB was 0.5%. Computerized Tomography (CT scan) was falsely negative in 44–50% of patients with laparoscopy after RYGB. ConclusionDiagnostic laparoscopy is more accurate than CT scan in evaluating patients with abdominal pain after RYGB.