Internal Hernia in Pregnant Women After Gastric Bypass: a Retrospective Register-Based Cohort Study.

Abstract

Pregnant women who have previously had laparoscopic Roux-en-Y gastric bypass surgery are increasingly seen in the acute surgical care setting with abdominal pain due to internal hernia. With this study, we want to contribute with our experience and to present our local surgical guidelines concerning this particularly vulnerable patient group. This article is a retrospective study on prospectively collected data. Using data from the Danish National Health Register, we identified 23 women who had bariatric surgery previously and who were admitted to our surgical department and operated on for suspicion of internal hernia. Additional data was collected from patient files and surgical files. We identified 23 women who all during pregnancy underwent surgery on suspicion of internal hernia; in 17 patients, the diagnosis was confirmed. We found that laparoscopic approach in our sample was performed as late as the 31st gestational week. All women and foetuses survived this dangerous condition, and none suffered from serious complications, nor did any of the patients have a bowel resection due to small bowel strangulation. In skilled clinical hands, internal hernia has a good prognosis in pregnant patients. Surgery may be performed subacutely or even electively, depending on the condition of patient and foetus, and straightforward clinical assessment is adequate, and imaging studies, e.g. CT, are not necessary.