Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany.
Department of General, Visceral and Thoracic Surgery, Hospital of Nuernberg, Nuernberg, Germany.
Langenbecks Arch Surg. 2023 Aug 17;408(1):318. doi: 10.1007/s00423-023-03049-2.
Internal hernia is one of the most frequent long-term complications after laparoscopic gastric bypass surgery (RYGB). Surgical treatment of an internal hernia itself has risks that can largely be avoided by the implementation of institutional standards and a structured approach.
From 2012 until 2022, we extracted all consecutive bariatric cases from the prospectively collected national database (StuDoQ). Data from all patients undergoing internal hernia repair were then collected from our hospital information management system and retrospectively analyzed. We compared patient characteristics and surgical outcome of patients before and after the implementation of standard operating procedures for institutional and perioperative aspects (first vs. second time span).
Overall, 37 patients were identified (median age 43 years, 86.5% female). Internal hernia was diagnosed after substantial weight loss (17.2 kg/m) and on average about 34 months after RYGB. Baseline characteristics (age, sex, BMI, achieved total weight loss% and time interval to index surgery were comparable between the two groups). After local standardization, the conversion rate decreased from 52.6 to 5.6% (p = 0.007); duration of surgery from 92 to 39 min (p = 0.003), and length of stay from 7.7 to 2.8 days (p = 0.019).
In this study, we could demonstrate that the surgical therapy of internal hernia after gastric bypass can be significantly improved by implementing institutional and surgical standards. The details described (including a video) may provide valuable information for non-specialized surgeons to avoid pitfalls and improve surgical outcomes.
内疝是腹腔镜胃旁路手术后（RYGB）最常见的长期并发症之一。内疝本身的手术治疗存在风险，通过实施机构标准和结构化方法可以在很大程度上避免这些风险。
从 2012 年到 2022 年，我们从前瞻性收集的全国数据库（StuDoQ）中提取了所有连续的减重手术病例。然后从我们的医院信息管理系统中收集了所有接受内疝修复手术的患者的数据，并进行回顾性分析。我们比较了实施机构和围手术期标准操作程序前后（第一时间段与第二时间段）患者的特征和手术结果。
总体上，确定了 37 例患者（中位数年龄 43 岁，86.5%为女性）。在体重明显减轻（17.2kg/m2）后并平均在 RYGB 后约 34 个月诊断出内疝。两组之间的基线特征（年龄、性别、BMI、实现的总体重减轻百分比和到索引手术的时间间隔）相当。经过局部标准化后，转化率从 52.6%降至 5.6%（p=0.007）；手术时间从 92 分钟降至 39 分钟（p=0.003），住院时间从 7.7 天降至 2.8 天（p=0.019）。
在这项研究中，我们可以证明通过实施机构和手术标准，可以显著改善胃旁路术后内疝的手术治疗。所描述的细节（包括视频）可能为非专业外科医生提供有价值的信息，以避免陷阱并改善手术结果。
