Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a relatively high incidence of internal hernias (IH) when compared to the open operation.A search in PubMed MEDLINE from January 1994 through January 2006 was performed (keywords: obesity, laparoscopy, gastric bypass and internal hernia).26 studies with a total of 11,918 patients were considered. 300 cases of IH occurred (rate 2.51\%). IH occurred 116 times at the level of the transverse colon mesentery (69\%), 30 at the Petersen's space (18\%), and 22 at the entero-enterostomy site (13\%). 142 re-operations were performed laparoscopically (85.6\%), and 24 by laparotomy (14.4\%). Bowel resection was done in 5 cases (4.7\%). Mortality was 1.17\%.IH after LRYGBP has an incidence of 2.51\%. Closure of mesenteric defects with non-absorbable running suture and antecolic Roux limb are recommended. Surgical exploration for suspicion of IH after LRYGBP should be first done by laparoscopy.