Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient.

Abstract

BACKGROUND:

While surgical exploration remains the gold standard for diagnosing internal hernia (IH) after certain bariatric surgeries, decisions for operative intervention are often based on computed tomography (CT) findings.

OBJECTIVES:

The aim of this study is to review our institutional experience and create an algorithm to approach patients presenting with abdominal pain and/or emesis after certain bariatric procedures.

SETTINGS:

University Hospital

METHODS:

Following institutional review board approval, a retrospective chart review of all patients presenting with obstruction symptoms after laparoscopic Roux-en-Y gastric bypass (LRYGB) was performed at 2 institutions from 2008 to 2013. Patients without CT scans or with incidental hernia defect findings were excluded. CT and intraoperative findings were compared via univariate statistical analysis.

RESULTS:

Fifty-two patients who underwent an operation for a suspected IH were identified. Of the 50 patients, 25 (50%) had IH at operation. Twenty-nine patients (58%) had positive CT scans read for IH and/or obstruction. Of these 29, 19 (66%) were found to have IH at operation and 10 (34%) underwent negative diagnostic laparoscopy. Of the 21 patients with negative CT scans, 6 (29%) had IH at operation versus 15 (71%) who were negative. The sensitivity of CT scan to detect an internal hernia is 76% with 95% confidence interval (CI) [53% to 90%] and specificity is 60% with 95% CI [39% to 78%]. Sensitivity increased to 96% with 95% CI [78% to 99.8%] when combining CT scans with neutrophilia findings.

CONCLUSION:

Positive CT scans are sensitive for IH but not specific. CT scans will not detect IH in 1:4 patients; despite negative findings, surgical exploration should remain the gold standard for patients with acute abdominal pain after LRYGB or biliopancreatic diversion when IH is a consideration.

• Authors: Maria S Altieri, Aurora D Pryor, Dana A Telem, Keneth Hall, Collin Brathwaite, Marlene Zawin
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2015 Nov-Dec Vol. 11 Issue 6 Pg. 1207-11 ISSN: 1878-7533 [Electronic] United States
• PMID: 25843399 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Algorithms
• Female
• Follow-Up Studies
• Gastric Bypass (adverse effects)
• Hernia, Abdominal (diagnostic imaging, etiology)
• Humans
• Male
• Obesity, Morbid (surgery)
• Postoperative Complications
• ROC Curve
• Retrospective Studies
• Tomography, X-Ray Computed (statistics & numerical data)