Abdominal pain and internal hernias after Roux-en-Y Gastric Bypass: are we dealing with the tip of an iceberg?

Abdominal pain and internal hernias after Roux-en-Y Gastric Bypass: are we dealing with the tip of an iceberg?

Authors

  • Francesco Tartamella Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma
  • Antonio Ziccarelli Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma
  • Stefano Cecchini Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma
  • Michelina Ferro Unità operativa di anestesia e rianimazione e terapia del dolore, Azienda ospedaliero universitaria di Parma
  • Matteo Riccò Azienda provinciale per i servizi sanitari della p.a di Trento, UOPSAL.,Trento, Italia
  • Edoardo Baldini Unità Operativa chirurgia Generale, Ospedale “G. da Saliceto”, Piacenza, Italia
  • Rudj Mancini UOC chirurgia bariatrica e metabolica, Azienda Ospedaliero Universitaria Pisana, Pisa, Italia
  • Marco Anselmino UOC chirurgia bariatrica e metabolica, Azienda Ospedaliero Universitaria Pisana, Pisa, Italia
  • Federico Marchesi Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Via Gramsci n.14, 43100 Parma Italia.

Keywords:

abdominal pain, gastric bypass, obesity, Peteresen hernia, internal hernia

Abstract

Background: Abdominal pain is the most frequent cause of hospital admission after Roux-en-y gastric bypass (RYGB). Among numerous possible underlying causes, internal hernias represent one of the most peculiar and insidious conditions, setting challenging diagnostic and therapeutic problems for the surgeon. The aim of this study is to analyze aspecific abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias. Methods: 13 patients submitted to internal hernia repair after laparoscopic antecolic RYGB and a group of 49 controls (non-complicated RYGB) have been assessed using a specific questionnaire. Overall aspecific abdominal pain incidence and characteristics have been analysed. Typical pain traits and predisposing conditions for internal hernias have been investigated. Results: 33% of controls reported aspecific abdominal pain after RYGB, mainly early postprandial, deep, remittent, colicky, located in the upper left abdomen. 77% of the case patients reported prodromal episodes of pain similar to the controls. The only significant differences between prodromal and acute episodes were pain intensity and quality (continuous). Excess weight lost at 3 months significantly correlated with internal hernia occurrence (p: 0.002). Conclusions: Based on abdominal pain characteristics, we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernia) in many patients after antecolic RYGB, only occasionally complicating. Therapeutic management of these cases remains controversial, being laparoscopic exploration a reasonable option when symptomatology is suggestive.

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Published

23-05-2019

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Section

ORIGINAL ARTICLES

How to Cite

1.
Tartamella F, Ziccarelli A, Cecchini S, Ferro M, Riccò M, Baldini E, et al. Abdominal pain and internal hernias after Roux-en-Y Gastric Bypass: are we dealing with the tip of an iceberg?. Acta Biomed [Internet]. 2019 May 23 [cited 2024 Jul. 20];90(2):251-8. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/7145