Internal Herniation and Weight Loss in Patients after Roux-en-Y Gastric Bypass

M.M.G. van Berckel*, J.C. Ederveen, J. Nederend, S.W. Nienhuijs

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)


Purpose Weight loss is one of the desired outcomes after a gastric bypass, in order to reduce co-morbidity, and even mortality. However, weight loss might contribute to a serious complication: internal herniation (IH). Pre-operative diagnosis of IH is demanding. This study was conducted to investigate if percentage total weight loss (%TWL) is clinically usable in recognizing patients with IH. Materials and Methods Patients who had undergone a gastric bypass between 2011 and 2014 were included retrospectively if a CT scan or reoperation was performed for suspected IH between 2011 and 2016. Differences in %TWL were calculated in patients with IH and without (NO-IH). A sub analysis was done in patients with complaints. A multivariate analysis to identify risk factors for IH was performed. Results Out of 1007 patients, 31 patients were diagnosed with an IH (3.1%) after a median time of 16.5 months (range 6.5-46.1). The %TWL was higher in patients with an IH (34.2% +/- 12.7) vs. NO-IH (30.8% +/- 9.6). This result was also seen in patients presenting with symptoms (IH 34.2% +/- 12.7 vs. NO-IH 27.0% +/- 14.8). If %TWL is above 30%, IH is significantly more diagnosed in patients presenting with symptoms. A multivariate logistic model for IH in patients presenting with symptoms identified both >= 30%TWL (adjusted OR 3.1, 95% CI 1.1-8.8, p = 0.036) and abdominal cramping (adjusted OR 3.2, 95% CI 1.2-8.5, p = 0.0021) as risk factors. Conclusion Our study showed significant more %TWL in patients with an IH. Both >= 30%TWL and cramping abdominal pain result in a threefold higher risk of presence of IH.
Original languageEnglish
Pages (from-to)2652-2658
Number of pages7
JournalObesity Surgery
Issue number7
Publication statusPublished - 1 Jul 2020


  • %twl
  • abdominal-pain
  • bariatric surgery
  • complication
  • complications
  • ct signs
  • diagnosis
  • gastric bypass
  • internal herniation
  • limb
  • mesenteric defects
  • morbidly obese
  • non-closure
  • percentage total weight loss
  • small-bowel obstruction
  • surgery
  • total weight loss
  • weight loss
  • Gastric bypass
  • Bariatric surgery
  • Percentage total weight loss
  • Complication
  • Total weight loss
  • Weight loss
  • LIMB
  • Internal herniation
  • %TWL

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