Wang Yi-Jie, Pan Hsin-Mei, Ser Kong-Han, Hsu Kuo-Feng
Division of General Surgery, Department of Surgery/Bariatric and Metabolic Surgery & Weight Management Center, Tri‑Service General Hospital, National Defense Medical Center, Taipei.
Bariatric and Metabolic Surgery Center, Ten-Chan General Hospital, Taoyuan, Taiwan.
Surg Laparosc Endosc Percutan Tech. 2025 Aug 1;35(4):e1376. doi: 10.1097/SLE.0000000000001376.
Obesity is a global health concern associated with multiple comorbidities, and bariatric surgery remains one of the most effective interventions for sustained weight loss and metabolic improvement. The Single Anastomosis Sleeve Ileal (SASI) bypass is a novel procedure that offers a simplified surgical approach while maintaining efficacy. However, despite its advantages, SASI bypass carries a risk of postoperative complications, including internal herniation-related bowel obstruction-a rare but potentially life-threatening condition requiring prompt recognition and intervention.
We report 3 cases of internal herniation following SASI bypass, 2 performed robotically and 1 laparoscopically. Despite uneventful surgical procedures, all 3 patients developed postoperative internal herniation, with symptom onset ranging from 1 week to 16 months after surgery. A comparative summary of their clinical presentations and outcomes is provided in the accompanying table. Due to timely diagnosis and prompt surgical intervention, all patients had favorable outcomes. In addition, we compiled and edited a surgical video from the third case to illustrate the operative management of this complication.
Computed tomography (CT) emerged as the gold standard for diagnosis, although immediate surgical exploration was necessary in cases of peritonitis or hemodynamic instability. Notably, 1 patient (Case 2) experienced rapid weight loss, a factor previously implicated as a potential risk for internal herniation. Petersen's defect was the most common herniation site in SASI bypass, resembling the pattern seen in One Anastomosis Gastric Bypass (OAGB) but differing from Roux-en-Y Gastric Bypass (RYGB), where multiple mesenteric defects increase the risk. While a longer biliopancreatic limb may predispose SASI and OAGB patients to herniation, consensus on routine defect closure remains lacking.
Internal herniation is a rare but serious complication of SASI bypass, with delayed diagnosis potentially leading to bowel ischemia or perforation. CT is essential for early detection, while timely surgical intervention is critical in symptomatic cases. The necessity of routine Petersen's defect closure remains debated, highlighting the need for further studies to determine the true incidence and optimal prevention strategies.
肥胖是一个全球性的健康问题，与多种合并症相关，而减重手术仍然是实现持续体重减轻和代谢改善的最有效干预措施之一。单吻合口回肠袖状（SASI）旁路术是一种新型手术，它提供了一种简化的手术方法，同时保持疗效。然而，尽管具有优势，但SASI旁路术仍有术后并发症的风险，包括与内疝相关的肠梗阻——这是一种罕见但可能危及生命的情况，需要及时识别和干预。
我们报告了3例SASI旁路术后发生内疝的病例，其中2例通过机器人手术完成，1例通过腹腔镜手术完成。尽管手术过程顺利，但所有3例患者均发生了术后内疝，症状出现时间为术后1周至16个月。随附表格提供了他们临床表现和结局的比较总结。由于及时诊断和迅速的手术干预，所有患者均取得了良好的结局。此外，我们编辑了第三例病例的手术视频，以说明该并发症的手术处理。
计算机断层扫描（CT）已成为诊断的金标准，尽管在腹膜炎或血流动力学不稳定的情况下需要立即进行手术探查。值得注意的是，1例患者（病例2）体重迅速减轻，这一因素先前被认为是内疝的潜在风险。彼得森氏缺损是SASI旁路术中最常见的疝出部位，类似于单吻合口胃旁路术（OAGB）中的情况，但与 Roux-en-Y 胃旁路术（RYGB）不同，后者多个肠系膜缺损会增加风险。虽然较长的胆胰支可能使SASI和OAGB患者易发生疝出，但对于常规缺损闭合仍缺乏共识。
内疝是SASI旁路术一种罕见但严重的并发症，延迟诊断可能导致肠缺血或穿孔。CT对于早期检测至关重要，而在有症状的病例中及时的手术干预至关重要。常规闭合彼得森氏缺损的必要性仍存在争议，这突出表明需要进一步研究以确定真实发病率和最佳预防策略。
