Obesity Surgery

, Volume 19, Issue 4, pp 527–530 | Cite as

A New Type of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

  • A. Paroz
  • J. M. Calmes
  • S. Romy
  • V. Giusti
  • M. SuterEmail author
Case Report


Roux-en-Y gastric bypass (RYGBP) is currently the most common bariatric procedure. One of its late complications is the development of internal hernia, which can lead to acute intestinal obstruction or recurrent colicky abdominal pain. The aim of this paper is to present a new, unusual, and so far not reported type of internal hernia. A common computerized database is maintained for all patients undergoing bariatric surgery in our departments. The charts of patients with the diagnosis of internal hernia were reviewed. Three patients were identified who developed acute intestinal obstruction due to an internal hernia located between the jejunojejunostomy and the end of the biliopancreatic limb, directly between two jejunal limbs with no mesentery involved. Another seven patients with intermittent colicky abdominal pain, re-explored for the suspicion of internal hernia, were found to also have an open window of the same location apart from a hernia at one of the typical hernia sites. Since this gap is systematically closed during RYGBP, no other patient has been observed with this problem. Even very small defects can lead to the development of internal hernias after RYGBP. Patients with suggestive symptoms must be explored. Closure of the jejunojejunal defect with nonabsorbable sutures prevents the development of an internal hernia between the jejunal loops at the jejunojejunostomy.


Gastric bypass Laparoscopy Internal hernia Complications 


  1. 1.
    Ianelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–71.CrossRefGoogle Scholar
  2. 2.
    Paroz A, Calmes JM, Giusti V, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg. 2005;15:1482–7.Google Scholar
  3. 3.
    Quebbeman BB, Dallai RM. The orientation of the antecolic Roux limb markedly affects the incidence of internal hernias after laparoscopic gastric bypass. Obes Surg. 2005;15:766–70.CrossRefGoogle Scholar
  4. 4.
    Fobi MAL, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.CrossRefGoogle Scholar
  5. 5.
    Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass. Arch Surg. 2003;138:957–61.CrossRefGoogle Scholar
  6. 6.
    Higa K, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350–4.CrossRefGoogle Scholar
  7. 7.
    Comeau E, Gagner M, Inabnet WB, et al. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005;19:34–9.CrossRefGoogle Scholar
  8. 8.
    Gutt CN, Oniu T, Schemmer P, et al. Fewer adhesions induced by laparoscopic surgery. Surg Endosc. 2004;18:898–906.CrossRefGoogle Scholar
  9. 9.
    Suter M, Giusti V, Heraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • A. Paroz
    • 1
  • J. M. Calmes
    • 1
  • S. Romy
    • 1
  • V. Giusti
    • 2
  • M. Suter
    • 1
    • 3
    Email author
  1. 1.Department of Visceral SurgeryCHUVLausanneSwitzerland
  2. 2.Division of Endocrinology, Diabetology, and MetabolismCHUVLausanneSwitzerland
  3. 3.Department of SurgeryHôpital du ChablaisAigleSwitzerland

Personalised recommendations