Internal Herniation and Weight Loss in Patients after Roux-en-Y Gastric Bypass
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ORIGINAL CONTRIBUTIONS
Internal Herniation and Weight Loss in Patients after Roux-en-Y Gastric Bypass M. M. G. van Berckel 1 & J. C. Ederveen 2 & J. Nederend 3 & S. W. Nienhuijs 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Weight loss is one of the desired outcomes after a gastric bypass, in order to reduce co-morbidity, and even mortality. However, weight loss might contribute to a serious complication: internal herniation (IH). Pre-operative diagnosis of IH is demanding. This study was conducted to investigate if percentage total weight loss (%TWL) is clinically usable in recognizing patients with IH. Materials and Methods Patients who had undergone a gastric bypass between 2011 and 2014 were included retrospectively if a CT scan or reoperation was performed for suspected IH between 2011 and 2016. Differences in %TWL were calculated in patients with IH and without (NO-IH). A sub analysis was done in patients with complaints. A multivariate analysis to identify risk factors for IH was performed. Results Out of 1007 patients, 31 patients were diagnosed with an IH (3.1%) after a median time of 16.5 months (range 6.5–46.1). The %TWL was higher in patients with an IH (34.2% ± 12.7) vs. NO-IH (30.8% ± 9.6). This result was also seen in patients presenting with symptoms (IH 34.2% ± 12.7 vs. NO-IH 27.0% ± 14.8). If %TWL is above 30%, IH is significantly more diagnosed in patients presenting with symptoms. A multivariate logistic model for IH in patients presenting with symptoms identified both ≥ 30%TWL (adjusted OR 3.1, 95% CI 1.1–8.8, p = 0.036) and abdominal cramping (adjusted OR 3.2, 95% CI 1.2–8.5, p = 0.0021) as risk factors. Conclusion Our study showed significant more %TWL in patients with an IH. Both ≥ 30%TWL and cramping abdominal pain result in a threefold higher risk of presence of IH. Keywords Gastric bypass . Bariatric surgery . Internal herniation . Complication . Weight loss . Total weight loss . Percentage total weight loss . %TWL
Introduction Weight loss is one of the desired outcomes after gastric bypass (GBP). The results are excellent, both in terms of weight reduction and improvement of co-morbidities, leading to a significant M. M. G. van Berckel and J. C. Ederveen contributed equally to this work. * M. M. G. van Berckel [email protected] 1
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
2
Department of Radiology, Maastricht University Hospital, Maastricht, The Netherlands
3
Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
reduction in mortality [1–4]. However, reduction in weight might contribute to one of the well-known and serious complications of gastric bypass surgery: internal herniation (IH) [5–8]. In general, experts assume that increased rates of IH after laparoscopic surgery occur due to lack of adhesions [9], and as a result of weight loss as the amount of intraabdominal fat declines [5, 10–17]. This shift leads to subsequent enlargement of the surgically created mesente
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