Laparoscopic repair of an internal hernia at the Petersen's defect after one anastomosis gastric bypass (OAGB): A case report.

INTRODUCTION

The One Anastomosis Gastric Bypass (OAGB) is increasingly prevalent as a primary and revision bariatric surgical procedure as it demonstrates a remarkable weight loss outcome. One of the benefits of OAGB is the low incidence of internal hernias (IHs); IHs after OAGB have rarely been documented.

CASE PRESENTATION

We describe the laparoscopic repair of an IH in a 54-year-old female with a one-year history of OAGB performed as a revision surgery after sleeve gastrectomy for weight regain. She presented to the emergency room with a sudden onset abdominal pain and constipation mimicking IH, which was diagnosed laparoscopically after a non-conclusive findings on double contrast computed tomography (CT) scan of the abdomen and pelvis.

DISCUSSION

Clinical presentation of IH after OAGB ranges from asymptomatic to being manifested as an acute abdomen. The difficulty in managing IHs lies in its accurate diagnosis. Physical examinations and laboratory tests are typically unreliable. The CT findings may be unremarkable in patients with intermittent symptoms. In the literature, diagnostic laparoscopy is considered the cornerstone of the diagnosis and management of highly apprehensive cases of IH with non-conclusive CT findings. A late diagnosis may lead to a dramatic increase in morbidity and mortality rates. Thus, in this case, we considered early intervention for the diagnosis and repair of IH.

CONCLUSIONS

IH should be suspected in patients with vague abdominal pain after OAGB and normal CT findings, warranting early intervention. Moreover, we demonstrated that OAGB does not eliminate the risk of IH development.