Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass

Background: Internal hernia rate after Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is variable (0.5%–9%). Methods: We retrospectively reviewed all patients who underwent diagnostic laparoscopy for possible internal hernia after RYGB from 2009 to 2016. All internal hernia defects were closed. Results: We performed 574 RYGB cases between 2013 and 2016, 33 diagnostic laparoscopies were performed (6 after RYGB done at our institution & 27 after RYGB done at outside institutions). Diagnostic laparoscopies after RYGB done at our institution showed internal hernia in 3/6 (50%), none at Petersen space, none had incarcerated small bowel or were converted to open. While 20/27 (74%) of diagnostic laparoscopies after RYGB done at outside institutions had an internal hernia, 18/20 (90%) at Petersen space, 15/27 (55%) had incarcerated small bowel and 3.7% needed small bowel resection or were converted to open. Our internal hernia rate after RYGB was 0.5%. Computerized Tomography (CT scan) was falsely negative in 44–50% of patients with laparoscopy after RYGB. Conclusion: Diagnostic laparoscopy is more accurate than CT scan in evaluating patients with abdominal pain after RYGB.