Internal Herniation in Pregnancy After Gastric Bypass
- 1 June 2016
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 127 (6), 1013-1020
- https://doi.org/10.1097/aog.0000000000001429
Abstract
To assess maternal and fetal outcomes of pregnancies complicated by internal herniation after Roux-en-Y gastric bypass. Articles were identified through searches in online databases (ClinicalTrials.gov, MEDLINE, EMBASE, PubMed, and Google Scholar) from January 1980 to March 2015 for the following terms: [gastric bypass OR bariatric surgery] AND [pregnancy] AND [complication OR herniation OR obstruction]. Reference lists of relevant articles were hand-searched. Additionally, we searched our own hospital's obstetric database for cases of internal herniation after Roux-en-Y gastric bypass. Only articles in English and studies in humans were selected. Cases of internal herniation outside of pregnancy or internal herniation without a history of Roux-en-Y gastric bypass were excluded. Of 384 articles identified by the initial search, 22 were retained for further analysis. All retrieved articles were case reports or case series. There were no interventional studies. We retrieved 47 cases from the literature and five cases from our own database. The mean gestational age at diagnosis was 28.4±7.3 weeks. All women presented with abdominal pain. Nausea and vomiting were present in only 65%. Ultrasonography and laboratory results are usually noninformative, and computed tomography or magnetic resonance imaging confirmed the diagnosis in only 75% of cases. Nine of 52 women (17.3%) required bowel resections. There were two maternal deaths and three perinatal deaths, all in women treated later than 48 hours after onset of the symptoms. Internal herniation complicating pregnancy after Roux-en-Y gastric bypass typically presents with subtle signs in the third trimester of pregnancy. Timely recognition and early surgical intervention are associated with a reduced risk of bowel ischemia and maternal and fetal adverse outcomes.Keywords
This publication has 30 references indexed in Scilit:
- Internal hernias in pregnant women with history of gastric bypass surgery: Case series and review of literatureInternational Journal of Surgery Case Reports, 2013
- Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal herniaSurgical Endoscopy, 2010
- Laparoscopic repair of internal hernia during pregnancy after Roux-en-Y gastric bypassSurgery for Obesity and Related Diseases, 2010
- Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never endsSurgery for Obesity and Related Diseases, 2009
- Reproductive outcome after bariatric surgery: a critical reviewHuman Reproduction Update, 2008
- Small bowel obstruction complicating pregnancy after laparoscopic gastric bypassSurgery for Obesity and Related Diseases, 2006
- Successful surgical treatment of a pregnancy-induced Petersen’s hernia after laparoscopic gastric bypassSurgery for Obesity and Related Diseases, 2005
- Pregnancy After Gastric Bypass Surgery and Internal Hernia FormationObstetrics & Gynecology, 2005
- Maternal and Fetal Deaths after Gastric Bypass Surgery for Morbid ObesityThe New England Journal of Medicine, 2004
- THE SAFETY AND DURATION OF NON‐OPERATIVE TREATMENT FOR ADHESIVE SMALL BOWEL OBSTRUCTIONAnz Journal of Surgery, 1993