2023, Number 1
<< Back Next >>
Acta Med 2023; 21 (1)
Incidental chyloperitoneum associated with internal hernia in post Roux-en-Y gastric bypass patients
Myers EJA, Blanco VJA, Maldonado VMA, Castillo GFA
Language: Spanish
References: 14
Page: 32-35
PDF size: 134.41 Kb.
ABSTRACT
Introduction: chyloperitoneum is an infrequent and under-reported complication of Roux-en-Y gastric bypass (RYGB). It is the presence of a milky liquid with a high-fat content (triglycerides > 110 mg/dL), secondary to obstruction and loss of lymphatic flow.
Material and methods: this article reports five cases of patients undergoing RYGB by laparoscopy who were reoperated for suspected intestinal obstruction and in whom chyloperitoneum was found as an intraoperative finding.
Results: the presence of an internal hernia by a defect in the jejunal space was found in the five patients. The result of the cytochemical examination of free fluid found during diagnostic surgery for chyloperitoneum. The diagnosis was associated with an obstructive presentation in all patients, resolving with the reduction of the hernia and correction of the mesenteric defect.
Conclusion: chyloperitoneum is a rare complication in patients with internal hernia with RYGB, with few cases reported in the literature. Although it is considered a rare complication, it can indicate internal hernias when the diagnosis is inconclusive. It may well be resolved during diagnostic laparoscopy by reducing the internal hernia and closing the mesenteric defect.
REFERENCES
Hidalgo JE, Ramirez A, Patel S, Acholonu E, Eckstein J, Abu-Jaish W et al. Chyloperitoneum after laparoscopic Roux-en-Y gastric bypass (LRYGB). Obes Surg. 2010; 20 (2): 257-260.
Krizek TJ, Davis JH. Acute chylous peritonitis. Arch Surg. 1965; 91 (2): 253-262.
Doherty GM. Peritoneal cavity. Chapter 22. In: Doherty GM, Way LW, editors. Current surgical diagnosis and treatment. 12th ed. New York: McGraw-Hill; 2005.
González-Chávez MA, Villegas-Tovar E, Faes-Petersen R, Huacuja-Blanco RR, Díaz-Girón-Gidi A, González Hermosillo-Cornejo D et al. Chylous ascites as a complication of laparoscopic Roux-en-Y gastric bypass: A case report and review of the literature. Med Sur. 2016; 23 (1): 53-57.
Al Harakeh AB, Kallies KJ, Borgert AJ, Kothari SN. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2016; 12 (1): 194-198.
Steele KE, Prokopowicz GP, Magnuson T, Lidor A, Schweitzer M. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc. 2008; 22 (9): 2056-2061.
Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment, and prevention. Obes Surg. 2003; 13 (3): 350-354.
Facchiano E, Leuratti L, Veltri M, Quartararo G, Iannelli A, Lucchese M. Laparoscopic management of internal hernia after Roux-en-Y gastric bypass. Obes Surg. 2016; 26 (6): 1363-1365.
Rogula T, Yenumula PR, Schauer PR. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007; 21 (11): 1914-1918.
Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005; 19 (1): 34-39.
Stenberg E, Szabo E, Agren G, Ottosson J, Marsk R, Lonroth H et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. Lancet. 2016; 387 (10026): 1397-1404.
Wang CY, Lin TA, Liu KH, Liao CH, Liu YY, Wu VCC et al. Serum asprosin levels and bariatric surgery outcomes in obese adults. Int J Obes (Lond). 2019; 43 (5): 1019-1025.
Harino Y, Kamo H, Yoshioka Y, Yamaguchi T, Sumise Y, Okitsu N et al. Case report of chylous ascites with strangulated ileus and review of the literature. Clin J Gastroenterol. 2015; 8 (4): 186-192.
Al-Saeed O, Fahmy D, Kombar O, Hasan A. Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery. Med Princ Pract. 2013; 22 (6): 540-544.