Obesity Surgery

, Volume 26, Issue 6, pp 1363–1365 | Cite as

Laparoscopic Management of Internal Hernia After Roux-en-Y Gastric Bypass

  • Enrico FacchianoEmail author
  • Luca Leuratti
  • Marco Veltri
  • Giovanni Quartararo
  • Antonio Iannelli
  • Marcello Lucchese
Video Submission



Internal hernia (IH) represents the most common cause of small-bowel obstruction after laparoscopic RYGBP. The anatomic changes resulting from RYGBP, the use of laparoscopy, and the postoperative weight loss all account for the high incidence of IH after this procedure. As the symptoms may be very vague, the interpretation of the clinical picture may result difficult. Moreover, laparoscopic treatment of IH could be very challenging for surgeons not familiar with the modified intestinal anatomy of the RYGBP.


The video shows the management of an IH at the Petersen’s defect.

A 51-year-old female was assessed for recurrent abdominal pain 3 years after a RYGBP. A CT scan showed the mesenteric swirl sign, so a diagnostic laparoscopy was performed.

The video first shows the identification of the herniated bowel through the mesenteric defect. Then, complete reduction of the IH and the closure of the Petersen’s defect are shown.


The total operative time was 35 min. The postoperative stay was uneventful and the patient was discharged in postoperative day one.


In case of clinical suspicion of IH, even in case of normal laboratory and radiological findings, a surgical exploration is indicated.


Internal hernia Roux-en-Y gastric bypass Complication Obesity Laparoscopy Bariatric surgery Intestinal obstruction 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no proprietary, financial, professional, or other personal interest of any nature or kind in any product or service that may influence the position presented.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained by all individual participants included in the study.

Supplementary material


(MP4 46053 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Enrico Facchiano
    • 1
    Email author
  • Luca Leuratti
    • 1
  • Marco Veltri
    • 1
  • Giovanni Quartararo
    • 1
  • Antonio Iannelli
    • 2
    • 3
    • 4
  • Marcello Lucchese
    • 1
  1. 1.Department of Surgery, Bariatric and Metabolic Surgery UnitSanta Maria Nuova HospitalFlorenceItaly
  2. 2.Centre Hospitalier Universitaire of Nice, Digestive Center, NiceCedex 3France
  3. 3.Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, C3M, Team 8, “Hepatic Complications in Obesity”, NiceCedex 3France
  4. 4.University of Nice-Sophia-Antipolis, Faculty of Medecine, NiceCedex 2France

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