Pregnant Patients with Internal Hernia after Gastric Bypass: A Single Center Experience

Abstract: Background Bariatric surgery has been a popular way for many women to reach a healthy body mass index, and as a consequence, a decreased body mass, which causes a greater chance of fertility, with improved pregnancy and better maternal outcomes. Objective Describe a single-center experience of pregnancies complicated by internal hernias after gastric bypass. Methods During 2011 and 2019 a series of patients were treated for an internal hernia after gastric bypass at our teaching hospital. The hospital records were retrospectively reviewed. Results Seven women were treated. Median age was 33 years (range: 24-39 years). Median gestational age was 25.6 weeks (range: 5-33 weeks). Median time from Roux-en-Y gastric bypass to pregnancy was 4 years (range: 1-7 years). Median body mass index was 24 kg/m2 (range: 24-31 kg/m2). Five (71.4%) patients underwent an exploratory laparotomy, and two (28.5%) patients a diagnostic laparoscopy. In all patients, an internal hernia of the small bowel in the Petersen space was encountered. Median length of pregnancy was 38 weeks (range: 33.6-39.6 weeks). Six (85.7%) patients underwent C-section, and one (14.2%) patient gave birth by vaginal delivery. There was only one maternal postoperative complication and no fetal post-operative complications. Median follow-up was 9 months (range: 2-20 months). Conclusion The rapid growth in bariatric surgery on obese women of fertile age could result in more cases of internal herniation during pregnancy in the future. An internal hernia should be suspected when encountering a post gastric bypass pregnant patient with abdominal pain, nausea, and vomiting.