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JVS-560; No. of Pages 2 ARTICLE IN PRESS

Journal of Visceral Surgery (2016) xxx, xxx—xxx

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SURGICAL IMAGES

Internal hernia after mini-gastric bypass:

Myth or reality?
E. Facchiano a,∗, A. Iannelli b,c,d, M. Lucchese a

a
Department of Surgery, General, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova
Hospital, Paizza Santa Maria Nuova, 50122 Florence, Italy
b
Centre hospitalier universitaire de Nice, Digestive Center, 06202 Nice cedex 3, France
c
Institut national de la santé et de la recherche médicale (Inserm), U1065, C3M, Team 8,
‘‘Hepatic Complications in Obesity’’, 06204 Nice cedex 3, France
d
University of Nice-Sophia-Antipolis, Faculty of Medicine, 06107 Nice cedex 2, France

KEYWORDS Summary The mini-gastric bypass (MGBP) is becoming an increasingly popular procedure
Internal hernia; worldwide. It is based on an ‘‘omega’’ reconstruction, resulting in a single anastomosis and in
Mini-gastric bypass; potential shortening of operative time. Internal hernia represents a potentially life-threatening
Obesity; complication after laparoscopic Roux-en-Y gastric bypass, but it has not yet been reported after
Complication; a mini-gastric bypass. We herein describe, for the first time, a case of internal hernia after this
Laparoscopy; surgery.
Bariatric surgery © 2016 Elsevier Masson SAS. All rights reserved.

The mini-gastric bypass (MGBP) is becoming an increasingly popular procedure worldwide

[1,2]. Among the advantages of a MGBP is the avoidance of needing a jejuno-jejunostomy
and a presumptive absence of an IH, with no cases of IH reported to date [1—3]. This has
led some authors to maintain that the closure of the only defect created during a MGBP is
not mandatory.
We herein present the intraoperative view of a case of internal hernia observed in a
49-year-old female patient one year after a mini-gastric bypass, after an excess weight
loss of 132%.
A diagnostic laparoscopy was done, which showed a large defect with herniation of
the afferent loop but no signs of intestinal ischemia (Fig. 1). The IH was reduced and the
mesenteric defect was closed using a running barbed suture (Fig. 2). The location and the
mechanism underlying the formation of an IH after mini-gastric bypass are showed in the
Fig. 3.

∗ Corresponding author. Tel.: +39 055 6938579.

E-mail address: enricofacchiano@yahoo.it (E. Facchiano).

http://dx.doi.org/10.1016/j.jviscsurg.2016.01.003
1878-7886/© 2016 Elsevier Masson SAS. All rights reserved.

Please cite this article in press as: Facchiano E, et al. Internal hernia after mini-gastric bypass: Myth or reality? Journal
of Visceral Surgery (2016), http://dx.doi.org/10.1016/j.jviscsurg.2016.01.003
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JVS-560; No. of Pages 2 ARTICLE IN PRESS
2 E. Facchiano et al.

Figure 1. A mesenteric defect between the transverse mesocolon

(TM) and the mesentery of the efferent limb (MEL). The herniated
afferent loop (HAL) has been partially reduced.

Figure 3. Schematic representation of internal hernia after mini-

gastric bypass.

needs further consideration in order to avoid a potentially

serious complication.

Figure 2. The IH has been reduced and the mesenteric defect has
been closed using a running barbed suture. TM: transverse meso-
colon; MEL: mesentery of the efferent limb.
The importance of our report lies in the fact that, for
the first time, we demonstrate a clear correlation between
MGBP and IH, suggesting that vague, non-explained abdom-
inal pain in patients with MGBP should raise a suspicion of
IH. Moreover, we show that a MGB does not eliminate the
risk to develop an IH. An important question arising from
our report is whether a mesenteric defect after MGB should
be systematically closed or not. Although a single observa-
tion is not enough to recommend the systematic closure of
a mesenteric defect after MGB, we think that the problem
Disclosure of interest
The authors declare that they have no competing interest.
References
[1] Musella M, Susa A, Greco F, et al. The laparoscopic mini-gastric
bypass: the Italian experience: outcomes from 974 consecutive
cases in a multicenter review. Surg Endosc 2014;28:156—63.
[2] Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC. Laparo-
scopic Roux-en-Y vs. mini-gastric bypass for the treatment
of morbid obesity: a 10-year experience. Obes Surg 2012;22:
1827—34.
[3] Mahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small
PK. ‘‘Mini’’-gastric bypass: systematic review of a controversial
procedure. Obes Surg 2013;23:1890—8.

Please cite this article in press as: Facchiano E, et al. Internal hernia after mini-gastric bypass: Myth or reality? Journal
of Visceral Surgery (2016), http://dx.doi.org/10.1016/j.jviscsurg.2016.01.003