Ventral Hernia Obstruction Post Laparoscopic Mini Gastric Bypass Leading to Gastrojejunostomy Leak
Shubham Bhatia, MD
| Product Details | |
| Product ID: | ACS-5990 |
| Year Produced: | 2020 |
| Length: | 5 min. |
Introduction:
Consensus on optimal timing of ventral hernia repair alongwith bariatric procedures has not been reached yet. Studies do affirm the risk of small bowel obstruction if hernias are left alone. We describe herniation of bowel through a ventral hernia defect leading to obstruction as well as leak at Gastrojejunostomy anastomosis site.
Presentation:
46 year-old female with BMI of 46 kg/m2 presented with repeated vomiting and abdominal distension after Laparoscopic Mini Gastric Bypass done elsewhere four days back. CECT abdomen revealed dilation of excluded stomach, duodenum, and jejunal loops. An anterior abdominal wall 42mm hernial defect with ileal loops was also noticed.
Patient was taken up for diagnostic laparoscopy for ventral hernia reduction. Approximately 100cm of small bowel was reduced from the 4cm x 4cm defect. In view of the infected and inflamed surgical site, a mesh was not placed. The defect was repaired anatomically using hybrid technique by a limited incision over the hernia site.
Intraoperative check endoscopy revealed a leak at the gastrojejunal anastomosis. The leak was sutured primarily using 2-0 vicryl. The omental fat pad was also sutured to the closed leak site for added safety.
Results:
POD1 Gastrograffin study revealed no leak and patient was discharged on day 3 on liquid diet. Patient is doing well with no hernia recurrence till date.
Conclusion:
Hernial defects should not be left un-repaired in bariatric procedures as herniation of bowel contents can lead to increased intra-luminal pressure which can in turn lead to leak.
Consensus on optimal timing of ventral hernia repair alongwith bariatric procedures has not been reached yet. Studies do affirm the risk of small bowel obstruction if hernias are left alone. We describe herniation of bowel through a ventral hernia defect leading to obstruction as well as leak at Gastrojejunostomy anastomosis site.
Presentation:
46 year-old female with BMI of 46 kg/m2 presented with repeated vomiting and abdominal distension after Laparoscopic Mini Gastric Bypass done elsewhere four days back. CECT abdomen revealed dilation of excluded stomach, duodenum, and jejunal loops. An anterior abdominal wall 42mm hernial defect with ileal loops was also noticed.
Patient was taken up for diagnostic laparoscopy for ventral hernia reduction. Approximately 100cm of small bowel was reduced from the 4cm x 4cm defect. In view of the infected and inflamed surgical site, a mesh was not placed. The defect was repaired anatomically using hybrid technique by a limited incision over the hernia site.
Intraoperative check endoscopy revealed a leak at the gastrojejunal anastomosis. The leak was sutured primarily using 2-0 vicryl. The omental fat pad was also sutured to the closed leak site for added safety.
Results:
POD1 Gastrograffin study revealed no leak and patient was discharged on day 3 on liquid diet. Patient is doing well with no hernia recurrence till date.
Conclusion:
Hernial defects should not be left un-repaired in bariatric procedures as herniation of bowel contents can lead to increased intra-luminal pressure which can in turn lead to leak.
