Gallo Ida Francesca, Marrelli Martina, Miligi Chiara Isabella, Spagnolo Giuseppe, Bruni Vincenzo
Bariatric Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy.
Updates Surg. 2025 Jan 15. doi: 10.1007/s13304-025-02072-w.
The rising prevalence of obesity has led to an increase in bariatric procedures, with laparoscopic Roux-en-Y gastric bypass (LRYGB) being one of the most commonly performed surgeries due to its efficacy and safety. However, internal hernia (IH) remains a significant complication post-LRYGB. The debate over preventive closure of mesenteric defects (MD) during LRYGB continues, with no consensus on the optimal technique. This study aims to document the incidence and management of symptomatic IH in patients undergoing LRYGB without preventive MD closure and compare findings with international literature. This retrospective study included patients undergoing LRYGB without preventive MD closure between January 2018 and December 2020. Demographic and clinical data were collected, and follow-up lasted approximately 3.5 years. Postoperative complications, including IH, were assessed. Among 261 patients who underwent LRYGB, 235 completed a minimal follow-up of 24 months. The incidence of IH was 5.9%, representing the most common cause of reoperation. Laparoscopic management successfully resolved 86% of IH cases, reaching 100% in early-diagnosed cases promptly referred to our surgical unit. Average surgical duration was 72 min, with a postoperative hospital stay of 48 h. Enhanced recovery protocols were employed for LRYGB patients. This study highlights the challenges in managing IH post-LRYGB without preventive MD closure. Although in our series IH incidence was lower than reported in many other studies, it still remains the most frequent complications following RYGB, suggesting that MD should be closed during primary surgery, when possible, as suggested by most recent studies. Standardized guidelines for MD closure are lacking, emphasizing the importance of appropriate surgical techniques. In our experience, laparoscopic management of IH was effective, especially in early-diagnosed cases.
肥胖症患病率的上升导致减肥手术的增加，腹腔镜Roux-en-Y胃旁路术（LRYGB）因其有效性和安全性成为最常实施的手术之一。然而，内疝（IH）仍是LRYGB术后的一个重大并发症。关于LRYGB术中预防性关闭肠系膜缺损（MD）的争论仍在继续，对于最佳技术尚未达成共识。本研究旨在记录未进行预防性MD关闭的LRYGB患者中症状性IH的发生率及处理情况，并将结果与国际文献进行比较。这项回顾性研究纳入了2018年1月至2020年12月期间未进行预防性MD关闭的LRYGB患者。收集了人口统计学和临床数据，随访时间约为3.5年。评估了包括IH在内的术后并发症。在261例行LRYGB手术的患者中，235例完成了至少24个月的随访。IH的发生率为5.9%，是再次手术的最常见原因。腹腔镜处理成功解决了86%的IH病例，早期诊断并及时转诊至我们外科的病例成功率达100%。平均手术时间为72分钟，术后住院时间为48小时。LRYGB患者采用了强化康复方案。本研究突出了未进行预防性MD关闭的LRYGB术后IH处理中的挑战。尽管在我们的系列研究中IH发生率低于许多其他研究报道，但它仍是RYGB术后最常见的并发症，这表明如最近研究所建议的，在可能的情况下，应在初次手术时关闭MD。目前缺乏MD关闭的标准化指南，强调了适当手术技术的重要性。根据我们的经验，腹腔镜处理IH是有效的，尤其是在早期诊断的病例中。
