Incidence and management of internal hernia after laparoscopic Roux-en-Y gastric bypass without preventive closure of mesenteric defects: a single-center retrospective study

The rising prevalence of obesity has led to an increase in bariatric procedures, with laparoscopic Roux-en-Y gastric bypass (LRYGB) being one of the most commonly performed surgeries due to its efficacy and safety. However, internal hernia (IH) remains a significant complication post-LRYGB. The debate over preventive closure of mesenteric defects (MD) during LRYGB continues, with no consensus on the optimal technique. This study aims to document the incidence and management of symptomatic IH in patients undergoing LRYGB without preventive MD closure and compare findings with international literature. This retrospective study included patients undergoing LRYGB without preventive MD closure between January 2018 and December 2020. Demographic and clinical data were collected, and follow-up lasted approximately 3.5 years. Postoperative complications, including IH, were assessed. Among 261 patients who underwent LRYGB, 235 completed a minimal follow-up of 24 months. The incidence of IH was 5.9%, representing the most common cause of reoperation. Laparoscopic management successfully resolved 86% of IH cases, reaching 100% in early-diagnosed cases promptly referred to our surgical unit. Average surgical duration was 72 min, with a postoperative hospital stay of 48 h. Enhanced recovery protocols were employed for LRYGB patients. This study highlights the challenges in managing IH post-LRYGB without preventive MD closure. Although in our series IH incidence was lower than reported in many other studies, it still remains the most frequent complications following RYGB, suggesting that MD should be closed during primary surgery, when possible, as suggested by most recent studies. Standardized guidelines for MD closure are lacking, emphasizing the importance of appropriate surgical techniques. In our experience, laparoscopic management of IH was effective, especially in early-diagnosed cases.