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The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?

Kawkabani Marchini, Aida ; Denys, Alban ; Paroz, Alexandre ; Romy, Sébastien ; Suter, Michel ; Desmartines, Nicolas ; Meuli, Reto ; Schmidt, Sabine

In: Obesity Surgery, 2011, vol. 21, no. 4, p. 506-516

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    Titre
    • The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?
    Auteur
    • Kawkabani Marchini, Aida. Department of Radiology, University Hospital—CHUV, 1011, Lausanne, Switzerland
    • Denys, Alban. Department of Radiology, University Hospital—CHUV, 1011, Lausanne, Switzerland
    • Paroz, Alexandre. Department of Visceral Surgery, University Hospital—CHUV, Lausanne, Switzerland
    • Romy, Sébastien. Department of Visceral Surgery, University Hospital—CHUV, Lausanne, Switzerland
    • Suter, Michel. Department of Visceral Surgery, University Hospital—CHUV, Lausanne, Switzerland
    • Desmartines, Nicolas. Department of Visceral Surgery, University Hospital—CHUV, Lausanne, Switzerland
    • Meuli, Reto. Department of Radiology, University Hospital—CHUV, 1011, Lausanne, Switzerland
    • Schmidt, Sabine. Department of Radiology, University Hospital—CHUV, 1011, Lausanne, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:314804
    Summary
    Background: Four different types of internal hernias (IH) are known to occur after laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for morbid obesity. We evaluate multidetector row helical computed tomography (MDCT) features for their differentiation. Methods: From a prospectively collected database including 349 patients with LRYGBP, 34 acutely symptomatic patients (28 women, mean age 32.6), operated on for IH immediately after undergoing MDCT, were selected. Surgery confirmed 4 (11.6%) patients with transmesocolic, 10 (29.4%) with Petersen's, 15 (44.2%) with mesojejunal, and 5 (14.8%) with jejunojejunal IH. In consensus, 2 radiologists analyzed 13 MDCT features to distinguish the four types of IH. Statistical significance was calculated (p < 0.05, Fisher's exact test, chi-square test). Results: MDCT features of small bowel obstruction (SBO) (n = 25, 73.5%), volvulus (n = 22, 64.7%), or a cluster of small bowel loops (SBL) (n = 27, 79.4%) were inconsistently present and overlapped between the four IH. The following features allowed for IH differentiation: left upper quadrant clustered small bowel loops (p < 0.0001) and a mesocolic hernial orifice (p = 0.0003) suggested transmesocolic IH. SBL abutting onto the left abdominal wall (p = 0.0021) and left abdominal shift of the superior mesenteric vessels (SMV) (p = 0.0045) suggested Petersen's hernia. The SMV predominantly shifted towards the right anterior abdominal wall in mesojejunal hernia (p = 0.0033). Location of the hernial orifice near the distal anastomosis (p = 0.0431) and jejunojejunal suture widening (p = 0.0005) indicated jejunojejunal hernia. Conclusions: None of the four IH seems associated with a higher risk of SBO. Certain MDCT features, such as the position of clustered SBL and hernial orifice, help distinguish between the four IH and may permit straightforward surgery