Laparoscopic Management of Internal Hernia After One Anastomosis Gastric Bypass (OAGB)
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MULTIMEDIA ARTICLE
Laparoscopic Management of Internal Hernia After One Anastomosis Gastric Bypass (OAGB) Enrico Facchiano 1
&
Emanuele Soricelli 1 & Marcello Lucchese 1
Received: 1 May 2020 / Revised: 9 June 2020 / Accepted: 17 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Among the advantages of the One Anastomosis Gastric Bypass (OAGB) are the lack of jejuno-jejunal anastomosis and a supposed lower incidence of internal hernia (IH), with only a few cases reported until now. However, the incidence of IH after OAGB is not null. We present a video of the laparoscopic management of an IH that occurred after an OAGB. The patient was a 49-year-old female who had undergone a laparoscopic revisional OAGB 2 years previously after a failed laparoscopic adjustable gastric banding. She was referred to our Unit for recurrent postprandial colicky pain. She lost a total of 50 kg and her body mass index (BMI) dropped from 38 to 19 kg/m2. A CT scan with intravenous contrast showed a swirl of the mesentery around the superior mesenteric artery, without small bowel obstruction. A laparoscopic exploration was performed, confirming the suspicion of IH at the Petersen’s space. An anticlockwise derotation of the whole common limb was performed, and the Petersen’s space was eventually closed with a running non-absorbable suture. Keywords Internal hernia . Gastric bypass . One anastomosis gastric bypass . OAGB . Mini gastric bypass . MGB . Obesity . Complication . Laparoscopy . Bariatric surgery . Small bowel obstruction
Introduction The one anastomosis gastric bypass (OAGB) is becoming an increasingly popular procedure worldwide [1, 2]. This is mainly because it not only demonstrates excellent results in terms of weight loss and the resolution of comorbidities but is also considered an easier procedure than the roux-en-y gastric bypass (RYGB) as it has a shorter operative time and a less steep learning curve [1, 3, 4]. Among the advantages of the OAGB are the lack of jejuno-jejunal anastomosis (JJA) and a Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04791-y) contains supplementary material, which is available to authorized users. * Enrico Facchiano [email protected] Emanuele Soricelli [email protected] Marcello Lucchese [email protected] 1
Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122 Florence, Italy
supposed lower incidence of internal hernia (IH), with only a few cases reported until now [5–7]. This has led to the assertion that the closure of the only Petersen’s defect created during an OAGB is not mandatory. We present a video of the laparoscopic management of an IH that occurred after an OAGB. Possible mechanisms to explain the different incidence of IH after OAGB and RYGB are discussed.
Methods Case Description The patient was a 49-year-old female who had undergone a laparoscopic revisional OAGB 2 years previously after a failed lapa
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