Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA.
Department of Family, Population & Preventive Medicine, Stony Brook School of Medicine, Stony Brook, NY, USA.
Surg Endosc. 2023 Sep;37(9):7183-7191. doi: 10.1007/s00464-023-10206-7. Epub 2023 Jun 22.
Internal hernia is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGB), with reported rates ~ 5% within three months to three years after surgery. Internal hernia through a mesenteric defect can lead to small bowel obstruction. Mesenteric defects began to be more routinely closed, often considered standard practice by 2010. To our knowledge, there are no large population-based studies looking at rates of internal hernia post-LRYGB. This study utilizes a statewide database to characterize the trends of internal hernia post-LRYGB over the last two decades in multiple centers.
LRYGB procedure records between January 2005 and September 2015 were extracted from the New York SPARCS database. Exclusion criteria included age < 18, in-hospital deaths, bariatric revision procedures, and internal hernia repair during the same hospitalization as LRYGB. Time to internal hernia was calculated from initial LRYGB hospital stay to admission date of the first internal hernia repair record. A multivariable proportional sub-distribution hazards model was utilized to analyze the trend of internal hernia incidence within three-year post-LRYGB.
46,918 patients were identified between 2005 and 2015, with 2950 (6.29) undergoing internal hernia repair post-LRYGB by the end of 2018. The cumulative incidence of internal hernia repair at the 3rd-year post-LRYGB was 4.80% (95% CI: 4.59%-5.02%). By the end of the 13th year, the longest follow-up period, the cumulative incidence was 12.00% (95% CI: 11.30%-12.70%). Overall, there was a decreasing trend over time of undergoing internal hernia repair within three-year post-LRYGB (HR = 0.94, 95% CI: 0.93-0.96), after adjusting for confounding factors.
This multicenter study maintains the rate of internal hernia following LRYGB reported in smaller studies and provides a longer follow-up period demonstrating decreasing occurrences of internal hernia after bypass as a function of year of index operation. This data is important as internal hernia continues to be a complication post-LRYGB.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后发生内疝是一种众所周知的并发症，术后 3 个月至 3 年内的报告发生率约为 5%。通过系膜缺陷发生的内疝可导致小肠梗阻。自 2010 年以来，系膜缺陷开始更常规地关闭，通常被认为是标准做法。据我们所知，目前尚无针对 LRYGB 术后内疝发生率的大型基于人群的研究。本研究利用全州数据库，在多个中心研究了过去二十年 LRYGB 术后内疝的趋势。
从纽约 SPARCS 数据库中提取 2005 年 1 月至 2015 年 9 月的 LRYGB 手术记录。排除标准包括年龄<18 岁、住院期间死亡、减重手术修正和 LRYGB 住院期间同时进行内疝修复。从初始 LRYGB 住院治疗到首次内疝修复记录的入院日期计算内疝发生时间。采用多变量比例亚分布风险模型分析 LRYGB 术后 3 年内内疝发生率的趋势。
2005 年至 2015 年间共确定了 46918 例患者，截至 2018 年底，有 2950 例（6.29%）在 LRYGB 术后接受了内疝修复。LRYGB 术后 3 年内内疝修复的累积发生率为 4.80%（95%CI：4.59%-5.02%）。在最长的 13 年随访期结束时，累积发生率为 12.00%（95%CI：11.30%-12.70%）。总体而言，在调整混杂因素后，LRYGB 术后 3 年内进行内疝修复的时间呈下降趋势（HR=0.94，95%CI：0.93-0.96）。
这项多中心研究维持了较小研究报告的 LRYGB 术后内疝发生率，并提供了更长的随访期，证明随着旁路索引手术年份的增加，内疝的发生次数减少。随着内疝继续成为 LRYGB 术后的一种并发症，该数据非常重要。
