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➤ Internal hernias (RNY/BPD-DS)
• Usually accompanied by intermittent, postprandial pain and emesis,
sometimes only pain.
• Herniation through defect in the mesentery created during the
surgical procedure.
• Challenging to diagnose both clinically and radiographically —
if suspected, diagnostic laparoscopy often needed, and surgical
consult should be considered even if imaging is negative.
• Surgical emergency if sudden/acute onset.
➤ Sleeve/pouch dilation (RNY/sleeve gastrectomy)
• Longer-term expansion of the residual stomach.
• May result in weight regain after sleeve gastrectomy or gastric
bypass.
• Treatment includes endoscopic reduction of dilated sleeve or pouch
reduction.
Early or Late
➤ Intestinal (small bowel) obstruction (RNY, BPD-DS, or open
procedure)
• Abdominal pain, nausea/vomiting, (constipation/obstipation not
present if partial).
• Usually, six months or longer out f rom surgery but can be anytime.
• May be associated with an internal hernia, narrowing of the roux
limb due to scarring, intussusception, and/or adhesions.
• Evaluation: CT scan abdomen most common but can also be seen
on plain flat/upright abdominal x-rays.
➤ Stricture (stomal stenosis) (RNY, sleeve gastrectomy, or BPD-DS)
• Postprandial, epigastric abdominal pain and vomiting (often with
f rothy emesis).
• Usually, 4–6 weeks following RNY.
• May result f rom narrowing of the anastomosis or angulation of the
intestinal limbs.
• May be associated with anastomotic ulcer (RNY and BPD-DS).
• EGD +/− balloon dilation: surgery only after multiple failed dilations.
➤ Band obstruction: band too tight, band slip/prolapse (LAGB)
• Abdominal pain, reflux, and regurgitation of undigested food
which occurs postprandially.
• Weight gain can occur due to dependence on liquid calories.
• Diagnostic testing: Can be clinical diagnosis, or upper GI imaging/
EGD.
• Surgery indicated for a slip which is not relieved after the complete
removal of all band fluid.
