« Back

Rapid weight loss can lead to internal hernia after laparoscopic gastric bypass

Monday, October 20 2008 | Comments

---

What's This? By David MacDougall

Rapid excess weight loss following laparoscopic gastric bypass (LGB) surgery is associated with an increased risk of internal hernia (IH), researchers report.

"IH is one of the more acute and potentially devastating complications after LGB," said Dr. Christopher Schneider of Greenville Hospital University Medical System in Greenville, S.C. "Currently, there is no way to predict which patients will develop IH."

In a retrospective study, Dr. Schneider and colleagues examined the medical records of 786 patients who underwent LGB between 2002 and 2007 to determine the relationship between the rate of postoperative weight loss and risk of IH following LGB. All surgical procedures were performed ante-colic with closure of all potential IH sites.

The mean preoperative body mass index among the patients was 47 kg/m2. Based on cumulative averages, the expected rate of excess weight loss at 1, 3, 6, 9, and 12 months postoperatively was 20%, 40%, 60%, 75%, and 85%, respectively.

Overall, 24 patients (3%) developed IH postoperatively. The mean length of time to the development of IH following LGB was 21 months.

Of the 24 patients who developed IH, 19 (79%) had periods of postoperative weight loss >125% of the predicted rate at 1 or more postoperative time points. In contrast, 7 (29%) of the 24 patients with IH exhibited expected rates of postoperative weight loss.

The most common locations of IH were Petersen's defect (8 cases), the mesentery of the jejuno-jejunostomy (8 cases), and the transverse colon mesentery (6 cases).
 
"Outcomes from missed IH can be catastrophic," the researchers concluded. "In our large, single center series, we have found patients who undergo periods of rapid excess weight loss exceeding our institution's average are at increased risk for the development of IH." (Surgical Forum 20: Alimentary Tract II)

Print  |  E-mail