Abdominal Pain After Roux-en-Y Gastric Bypass: Semiotic Aspects Suggestive of Internal Hernias

Introduction: Abdominal pain is the most frequent cause of hospital admission after Roux en y gastric bypass (RYGB) Among numerous possible underlying causes, internal hernia represents one of the most peculiar and insidious circumstances, setting challenging diagnostic and therapeutic problems for the surgeon. Objectives: The aim of this study is to analyze abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias. Methods: 9 patients submitted to internal hernia repair after RYGB and a group of 49 controls (non complicated RYGB) were evaluated using 2 types of abdominal pain questionnaires (Roma III and Roma III modified). Overall abdominal pain incidence (controls) and specific characteristics of internal hernias (cases) were analyzed. Results: 32% of controls presented aspecific (no diagnosed cause) abdominal pain after RYGB - mainly deep, remittent, colic, located in the upper left abdomen, postprandial. 78% of the cases presented prodromic algic episodes similar to those of the controls, differing from the acute episode only in pain intensity. Excess weight loss, mainly at 3 months and after one year, showed the most significant correlation with internal hernia (p: 0.043 and p: 0,026, respectively). Conclusion: Based on abdominal pain characteristics (angina abdominis-like) we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernias) in many patients, occasionally complicating. Therapeutic management of such cases remains controversial, laparoscopic exploration being a good option when symptomatology is suggestive.