Internal herniation of small bowel through the minimizer ring after banded one anastomosis gastric bypass: Case report with diagnosis and management of a rare complication - 06/09/22

Doi : 10.1016/j.orcp.2022.06.004

Bruno Sensi ^a,^b, Lorenza Beomonte Zobel ^a,^b,^⁎ , Valerio Forte ^b, Federica Alicata ^a,^b, Chiara Procaccini ^a,^b, David Pavoncello ^a,^b, Claudio Arcudi ^a,^b, Emanuela Bianciardi ^c, Paolo Gentileschi ^a,^b
^a Department of Surgery, University of Rome Tor Vergata, Rome, Italy
^b Department of Bariatric and Metabolic Surgery, San Carlo di Nancy Hospital, Rome, Italy
^c Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy

^⁎Corresponding author at: Department of Surgery, University of Rome Tor Vergata, Rome, Italy.Department of Surgery, University of Rome Tor VergataRomeItaly

Abstract

Introduction

One Anastomosis Gastric Bypass has been increasingly performed in the setting of bariatric surgery. The addition of gastric pouch banding (BOAGB) may reduce weight regain in the long term. BOAGB may rarely be complicated by MiniMizer ring-related affections.

This article reports for the first time a case of bowel obstruction due to internal hernia (IH) through the ring itself, occurring 15 months after BOAGB.

Case report

A 55 years-old woman presented with unspecific symptoms of sub-acute bowel obstruction 15 months after BOAGB. Work-up revealed IH through the MiniMizer ring and its erosion into the liver. Successful management included laparoscopic ring removal and adhesion-lysis. Postoperative course was uneventful.

Discussion and conclusion

IH through MiniMizer ring is a rare complication of BOAGB and awareness of this possibility may help diagnosis and prevention. Diagnosis requires high index of suspicion and per-oral contrast CT. Successful management entails laparoscopic device removal. Prevention includes non re-absorbable suture fixation and adequate gastric pouch encirclement.

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Keywords : Bariatric Surgery, Obesity, One anastomosis gastric bypass, OAGB, Gastric bypass, Banded OAGB, BOAGB, MiniMizer ring, Internal Hernia, Slippage, Bowel obstruction