PDF(Pubmed)
Abstract：
Obesity is an emerging worldwide health care issue. It has a direct and indirect bearing on health-related outcomes. Rates of overweight and obesity have grown manifold in the past few decades globally. Once considered a problem of the affluent societies only, obesity is now dramatically on the rise in low- and middle-income countries also. Single anastomosis gastric bypass (SAGB) is one of the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy. Internal hernia (IH) after SAGB is a less recognized clinical entity. We hereby report our experience with four such cases under light of current available literature. Bariatric procedures are associated with some short- and long-term limitations. IHs are among one of the dreaded complications associated with some bariatric procedures with rates reaching up to 16% after classic Roux-en-Y gastric bypass. The incidence of IH post-SAGB is comparatively rare and is very less frequently reported. Symptoms of IH post-SAGB are quite nonspecific and depend on the time and extent of herniation. The symptoms can vary from benign intermittent colicky pain to severe intra-abdominal pain presenting as a surgical emergency. Routine physical examination and biochemical investigations are nonspecific and unreliable in evaluating those patients. Computed tomography (CT) with intravenous and oral contrast is the most common imaging modality used for preoperative evaluation of those symptoms. The CT findings can be unremarkable in patients having intermittent symptoms/herniation. Diagnostic laparoscopy is the cornerstone for diagnosis and management of patients having high suspicion of IH.
摘要：
肥胖是一个新兴的全球医疗保健问题。它对与健康相关的结果有直接和间接的影响。在过去的几十年中，超重和肥胖率在全球范围内增长了很多。曾经只被认为是富裕社会的问题，肥胖现在在低收入和中等收入国家也在急剧上升。单次吻合胃旁路术（SAGB）是用于最大药物治疗失败的患者减肥的联合减肥手术之一。SAGB后的内疝（IH）是一种较少认可的临床实体。根据现有文献，我们在此报告我们在四个此类案件中的经验。减重手术与一些短期和长期限制有关。IHs是与某些减肥手术相关的可怕并发症之一，在经典的Roux-en-Y胃旁路术后，发生率高达16％。SAGB后IH的发生率相对较少，报告频率也很少。SAGB后IH的症状是非特异性的，取决于疝的时间和程度。症状可以从良性间歇性绞痛疼痛到严重的腹腔内疼痛不等。常规体格检查和生化检查在评估这些患者时是非特异性和不可靠的。具有静脉和口腔造影的计算机断层扫描（CT）是用于术前评估这些症状的最常见成像方式。在有间歇性症状/疝的患者中，CT表现可能不明显。诊断性腹腔镜检查是高度怀疑IH的患者的诊断和管理的基石。
