Santos Eduardo Pachu Raia Dos, Santa Cruz Fernando, Hinrichsen Eduarda Araújo, Ferraz Álvaro Antônio Bandeira, Campos Josemberg Marins
Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife, PE, Brasil.
Curso de Medicina, Universidade Federal de Pernambuco, Recife, PE, Brasil.
Arq Gastroenterol. 2019 Aug 13;56(2):160-164. doi: 10.1590/S0004-2803.201900000-32.
Internal hernia (IH) following laparoscopic Roux-en-Y gastric bypass (LRYGB) is a major complication that challenges the surgeon due to its non-specific presentation and necessity of early repair. Delayed diagnosis and surgical intervention of IH might lead to increased morbidity of patients and impairments in their quality of life.
To evaluate the predictive factors for early diagnosis and surgical repair of IH after LRYGB.
This study analyzed 38 patients during the postoperative period of LRYGB who presented clinical manifestations suggestive of IH after an average of 24 months following the bariatric procedure.
The sample consisted of 10 men and 28 women, with a mean age of 37.5 years and a mean body mass index (BMI) of 39.6 kg/m2 before LRYGB. All patients presented pain, 23 presented abdominal distension, 10 had nausea and 12 were vomiting; three of them had dysphagia, three had diarrhea and one had gastro-esophageal reflux. The patients presented symptoms for an average of 15 days, varying from 3 to 50 days. Seventeen (45.9%) patients were seen once, while the other 20 (54.1%) went to the emergency room twice or more times. Exploratory laparoscopy was performed on all patients, being converted to laparotomy in three cases. Petersen hernia was confirmed in 22 (57.9%). Petersen space was closed in all patients and the IH correction was performed in 20 (52.6%) cases. The herniated loop showed signs of vascular suffering in seven patients, and two (5.3%) had irreversible ischemia, requiring bowel resection.
The presence of recurrent abdominal pain is one of the main indicators for the diagnosis of IH after LRYGB. Patients operated at an early stage, even with negative imaging tests for this disease, benefited from rapid and simple procedures without major complications.
腹腔镜Roux-en-Y胃旁路术（LRYGB）后发生内疝（IH）是一种主要并发症，因其表现不具特异性且需早期修复，给外科医生带来挑战。IH的延迟诊断和手术干预可能导致患者发病率增加及生活质量受损。
评估LRYGB后IH早期诊断及手术修复的预测因素。
本研究分析了38例LRYGB术后患者，这些患者在减重手术后平均24个月出现提示IH的临床表现。
样本包括10名男性和28名女性，LRYGB术前平均年龄为37.5岁，平均体重指数（BMI）为39.6kg/m²。所有患者均有疼痛，23例有腹胀，10例有恶心，12例有呕吐；其中3例有吞咽困难，3例有腹泻，1例有胃食管反流。患者出现症状的平均时间为15天，范围为3至50天。17例（45.9%）患者就诊1次，其余20例（54.1%）前往急诊室2次或更多次。所有患者均接受了探查性腹腔镜检查，3例转为开腹手术。22例（57.9%）确诊为彼得森疝。所有患者均关闭了彼得森间隙，20例（52.6%）进行了IH矫正。7例患者的疝入肠袢出现血管受损迹象，2例（5.3%）出现不可逆缺血，需要进行肠切除。
反复出现腹痛是LRYGB后诊断IH的主要指标之一。早期接受手术的患者，即使针对该疾病的影像学检查结果为阴性，也能从快速简单的手术中获益，且无重大并发症。
