101 - Freie Mitteilung
Bariatry & hernia II
17. Mai 2019, 14:15 - 15:45, Bellavista 5, 6. OG
Development and validation of a prediction model for internal hernia after Roux en Y gastric bypass.
G. Giudicelli1, C. Toso2, P. Morel2, S. P. Mönig2, M. E. Hagen2, M. Vix3, M. Diana3, A. Lapergola3, M. Worreth1, A. Saadi1, A. Buman1, A. Platon2, P. A. Poletti2, M. K. Jung2, Presenter: G. Giudicelli1 (1Neuchâtel, 2Geneva, 3Strasbourg/FR)
Diagnosis of internal hernia (IH) after Roux-en-Y gastric bypass (RYGB) is challenging. Sensitivity of 63-92% was reported for computer tomography (CT). Laparoscopy remains paramount but yields surgical morbidity. We aimed to evaluate clinical and radiological signs of IH to develop and validate a prediction score.
Consecutive patients admitted for abdominal pain after RYGB which underwent CT and surgical exploration were retrospectively included. Patients with appendicitis or CT unavailable for review were excluded. Binary logistic regression was used to determine a predictive score of surgically confirmed IH on Geneva training set (January 2006 - December 2014) which was validated in three tertiary centres Geneva (January 2015 - December 2017), Neuchâtel (January 2012 - December 2017) and Strasbourg (January 2012 - December 2017).
228 patients were included, 80 (35.5%) had surgically confirmed IH, 38 (16.6%) had negative laparoscopy, 110 (48.2%) had an alternate diagnosis. In the training set of 61 patients, excess body weight loss>95% (OR 6.73 [95% CI, 1.13-39.96]), swirl sign (OR 8.93 [95% CI, 2.30-34.70]), and free liquid in one quadrant (OR 4.53 [95% CI, 1.08-19.0]) were independent predictors of IH. Equal point value of 1 was assigned to each predictor, C-statistic was 0.799. In the validation set of 167 patients, IH-score ≥ 2 was associated with an incidence of IH of 60.7% (34/56) and 5.3% (3/56) had negative laparoscopy, C-statistic was 0.846.
IH-score showed good performance and could be incorporated in a clinical setting. We would recommend explorative laparoscopy in patients with a score≥ 2.