72 - Freie Mitteilung
Bariatry & hernia I
16. Mai 2019, 17:30 - 19:00, Bellavista 3+4, 6. OG
Chronic pain following gastric bypass: Another argument to support mesenteric windows closure.
J. Douissard, P. Gambon-Stow, A. Dupuis, M. K. Jung, C. Toso, M. E. Hagen, Presenter: J. Douissard (Genève)
Chronic pain is a frequent long-term complication after Roux-en-Y gastric bypass (RYGB). Post-bypass mesenteric windows are well-known as a potential cause of acute internal herniations which need to be treated in emergency. But mesenteric windows may also lead to recurrent non-strangulating internal hernias responsible for non-specific chronic abdominal pain. This entity is however less described, physical examination being often poor and computed tomography (CT) limited to establish the diagnosis. Elective laparoscopy with closure of mesenteric windows may provide positive diagnosis and improve such symptoms.
Single-center university hospital institutional bariatric surgery database was searched retrospectively for cases of elective laparoscopy for chronic abdominal pain after RYGB over a 5 years period. Emergency cases such as strangulated internal hernias were not included in this analysis.
Eleven patients were included. Mean delay of 4.22.8 years was found between RYGB and exploratory laparoscopy. Beside pain, mild constipation was the most frequent symptom (7/11). None of the patients had primary closure of Peterson’s space and only 3 had primary closure of inter-mesenteric space. Open mesenteric windows were found in all cases (11/11), internal hernia in 6/11 cases. In 3 cases Peterson’s space had to be closed vs. 8 who needed closure of both inter-mesenteric and Peterson’s space. Primary closed inter-mesenteric spaces were found closed at laparoscopy. All closures were performed according to a standardized technique with 2-0 non-absorbable running suture. Nine patients were totally relieved from symptoms after mesenteric windows closure; substantial improvement was noted in the 2 remaining cases.
Elective laparoscopic windows closure leads in most cases to resolution of symptoms. These results support primary closure of mesenteric defects during RYGB and low threshold for laparoscopic exploration in situations of chronic post-operative abdominal pain.