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Ling XS, Anthony Brian Tian WC, Augustin G, Catena F. Can small bowel obstruction during pregnancy be treated with conservative management? A review. World J Emerg Surg 2024; 19:13. [PMID: 38600568 PMCID: PMC11007914 DOI: 10.1186/s13017-024-00541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/17/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Small bowel obstruction can occur during pregnancy, which, if missed, can lead to dire consequences for both the mother and foetus. Management of this condition usually requires surgical intervention. However, only a small number of patients are treated conservatively. OBJECTIVE The objective was to review the literature to determine the feasibility of conservative management for small bowel obstruction. METHODS A systematic search of the PubMed and Embase databases was performed using the keywords [small bowel obstruction AND pregnancy]. All original articles were then reviewed and included in this review if deemed suitable. CONCLUSION Conservative management of small bowel obstruction in pregnant women is feasible if the patient is clinically stable and after ruling out bowel ischaemia and closed-loop obstruction.
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Affiliation(s)
- Xiao Shuang Ling
- Department of General Surgery, Changi General Hospital, Singapore, Singapore.
| | | | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Fausto Catena
- General and Emergency Surgery Department, Bufalini Hospital, Cesena, Italy
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2
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Ayyash M, Miller M, Smith N, Espy J, Kim SK. Management of small bowel obstruction in the third trimester. BMJ Case Rep 2024; 17:e255843. [PMID: 38442967 PMCID: PMC10916100 DOI: 10.1136/bcr-2023-255843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Small bowel obstruction (SBO) in pregnancy is exceedingly rare. Management of SBO in the third trimester may pose particular challenges, as clinicians must determine whether or not the delivery of the fetus is indicated. In this report, we review the case of a patient in her mid-20's with no prior surgical history who presented with nausea and vomiting at 34 weeks of gestation and was ultimately diagnosed with an SBO. Following expectant management during the initial 4 days of inpatient admission, the patient subsequently underwent an exploratory laparotomy at 35 weeks without concurrent delivery. She was monitored for the remainder of her pregnancy with non-stress tests to evaluate fetal status and eventually underwent induction of labour at 39 weeks, resulting in a successful vaginal delivery. Herein, we review the challenges related to the diagnosis and management of SBO in pregnancy, as well as the maternal-fetal outcomes in the setting of SBO in the third trimester.
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Affiliation(s)
- Mariam Ayyash
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Madison Miller
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Nicolina Smith
- Department of Women's Health, Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Jeannette Espy
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sun Kwon Kim
- Department of Women's Health, Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
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3
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Altieri MS, Carter J, Aminian A, Docimo S, Hinojosa MW, Cheguevara A, Campos GM, Eisenberg D. American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:763-771. [PMID: 37268518 DOI: 10.1016/j.soard.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jonathan Carter
- Department of General Surgery, University of California, San Francisco, California
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Salvatore Docimo
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Afaneh Cheguevara
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California
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4
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Brönnimann A, Jung MK, Niclauss N, Hagen ME, Toso C, Buchs NC. The Impact of Pregnancy on Outcomes After Bariatric Surgery. Obes Surg 2021; 30:3001-3009. [PMID: 32382960 DOI: 10.1007/s11695-020-04643-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bariatric surgery is performed mostly on obese women of reproductive age. Many studies have analyzed pregnancy outcomes after bariatric surgery, but only a small number have studied the impact of pregnancy on the postoperative outcomes. PURPOSE To study the effect of pregnancy on outcomes after bariatric surgery in women of childbearing age. METHODS From January 2010 to October 2017, a retrospective study of a prospectively maintained database was conducted at the University Hospital of Geneva (HUG), where 287 women between the ages of 18 and 45 years had undergone Roux-en-Y gastric bypass (RYGB). A comparison of the results during a 5-year follow-up was performed between women who became pregnant after their bariatric surgery (pregnancy group, n = 40) and postoperative non-pregnant women (non-pregnancy group, n = 247). The two groups were compared for weight loss, complications, and nutritional deficiencies. RESULTS The pregnancy group was significantly younger (29.2 ± 5.5 vs. 36.4± 6.3 years, p < 0.001) and heavier (124.0 ± 18.0 kg vs. 114.7 ± 17.1, p < 0.001) compared with the non-pregnancy group at the time of surgery. The percentage of excess BMI loss (%EBMI loss) was similar in both groups during the 5-year follow-up. Complications after RYGB and nutritional deficiencies were nearly identical in the two groups. The interval of time between bariatric surgery and first pregnancy was a median of 20.8 months. Out of 40 first pregnancies, 28 women completed pregnancy successfully with live birth. CONCLUSION Pregnancy after bariatric surgery is safe and does not adversely affect outcomes after RYGB.
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Affiliation(s)
| | - M K Jung
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - N Niclauss
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - M E Hagen
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - C Toso
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
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5
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Gonzalez-Urquijo M, Zambrano-Lara M, Patiño-Gallegos JA, Rodarte-Shade M, Leyva-Alvizo A, Rojas-Mendez J. Pregnant patients with internal hernia after gastric bypass: a single-center experience. Surg Obes Relat Dis 2021; 17:1344-1348. [PMID: 33858785 DOI: 10.1016/j.soard.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
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. SETTING Academic Medical Center. METHODS During 2011 and 2019 a series of patients were treated for 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 yr). Median gestational age was 25.6 weeks (range: 5-33 wk). Median time from Roux-en-Y gastric bypass to pregnancy was 4 years (range: 1-7 yr). Median body mass index was 24 kg/m2 (range: 24-31 kg/m2). Five (71.4%) patients underwent an exploratory laparotomy, and 2 (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 wk). Six (85.7%) patients underwent C-section, and 1 (14.2%) patient gave birth by vaginal delivery. There was only 1 maternal postoperative complication and no fetal postoperative complications. Median follow-up was 9 months (range: 2-20 mo). 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 postgastric bypass pregnant patient with abdominal pain, nausea, and vomiting.
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Affiliation(s)
| | - Mario Zambrano-Lara
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | | | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | - Adolfo Leyva-Alvizo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | - Javier Rojas-Mendez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México.
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6
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Bonouvrie DS, Boerma EJ, van Dielen FMH, Leclercq WKG. Internal herniation during pregnancy after banded Roux-en-Y gastric bypass: a unique location. BMJ Case Rep 2020; 13:13/12/e236798. [PMID: 33298482 DOI: 10.1136/bcr-2020-236798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 26-year-old multigravida, 30+3 weeks pregnant woman, was referred to our tertiary referral centre with acute abdominal pain and vomiting suspected for internal herniation. She had a history of a primary banded Roux-en-Y gastric bypass (B-RYGB). The MRI scan showed a clustered small bowel package with possible mesenteric swirl diagnosed as internal herniation. A diagnostic laparoscopy was converted to laparotomy showing an internal herniation of the alimentary limb through the silicone ring. The internal herniation was reduced by cutting the silicone ring. Postoperative recovery, remaining pregnancy and labour were uneventful. During pregnancy after B-RYGB, small bowel obstruction can in rare cases occur due to internal herniation through the silicone ring. Education regarding this complication should be provided before bariatric surgery. Treatment of women, 24 to 32 weeks pregnant, in a specialised centre for bariatric complications with a neonatal intensive care unit is advised to improve maternal and neonatal outcome.
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Affiliation(s)
| | - Evert-Jan Boerma
- Bariatric Surgery, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | - Francois M H van Dielen
- Obesity Centre Maxima, Maxima Medical Centre, Eindhoven/Veldhoven, Gelderland, The Netherlands
| | - Wouter K G Leclercq
- Obesity Centre Maxima, Maxima Medical Centre, Eindhoven/Veldhoven, Gelderland, The Netherlands
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7
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The Acute Abdomen in Pregnant Women After Roux-en-Y Gastric Bypass: Encouraging Results from a National Referral Centre. Obes Surg 2020; 30:4029-4037. [PMID: 32671725 DOI: 10.1007/s11695-020-04833-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women with a history of bariatric surgery (BS) may develop acute abdominal pain related to this surgery, especially after Roux-en-Y gastric bypass. Studies showed alarming results regarding maternal and foetal morbidity and mortality. The aim of this study was to analyse these outcomes for pregnant women and their offspring. METHODS Single-centre retrospective cohort study in a tertiary referral centre for bariatric complications during pregnancy. Pregnant women with a history of BS referred between September 2015 and November 2019 with acute abdominal pain suspected for a bariatric complication were included. Data were retrospectively collected from the patient files, and a questionnaire was sent regarding the postoperative course and childbirth. RESULTS Fifty women were included. At presentation, mean maternal age was 31 (± 4) years, and median gestational age was 28+4 (25+4, 30+5) weeks. Thirteen women were treated conservatively. Thirty-seven women underwent surgery for, among others, internal herniation (n = 26) and intussusception (n = 6). Six women required small bowel resection. Two women underwent an emergency caesarean section shortly after the surgery due to foetal distress. Eight women delivered preterm of whom five infants required respiratory support. There was one intrauterine foetal death. Surgery > 48 h after the onset of the symptoms was not associated with an increase in small bowel resections or preterm birth. CONCLUSION Acute abdominal pain in pregnant women may be related to a bariatric complication. Further awareness of bariatric complications within the obstetric care and transferal to specialized care to prevent diagnostic delay may improve maternal and neonatal outcome.
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8
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Yang S, Zhou L, Chen Y, Krewski D, Xie RH, Wen SW. The impact of pregnancy on postoperative outcomes among obese women who underwent bariatric surgery: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:239-245. [PMID: 32623256 DOI: 10.1016/j.ejogrb.2020.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Women who had a history of bariatric surgery are increasingly becoming pregnant. There is growing evidence showing that increased risk of postoperative complications may be associated with the gestation after bariatric surgery.The objective of this systematic review was to evaluate the potential impact of pregnancy on weight loss and postoperative complications in obese women after bariatric surgery. STUDY DESIGN PubMed, Embase, Medline and Cochrane Central Register of Controlled Trails were searched from inception through October 2018. Selection criteria included observational or randomized trial examining weight loss and medical complications in pregnant compared to non-pregnant women after bariatric surgery. Two reviewers extracted information and performed quality appraisal of eligible articles. Meta-analysis was performed to ascertain the certainty of the evidence when possible. RESULTS Seven observational cohort studies with a total of 27,369 obese women were included in the final analysis. The mean difference (95 % confidence interval) in percent excess weight loss between pregnant and non-pregnant subjects was -9.5 (-19.9, 0.9). The odds ratio (95 % confidence interval) for postoperative complications in pregnant relative to non-pregnant subjects was 0.85 (0.33, 2.18). CONCLUSIONS Pregnancy may have little or no effect on weight loss or postoperative complications in women who have undergone bariatric surgery.
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Affiliation(s)
- Siyu Yang
- Nursing School of Central South University, Changsha, Hunan, PR China.
| | - Leshan Zhou
- Nursing School of Central South University, Changsha, Hunan, PR China.
| | - Yijing Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China; Wuhan Mental Health Center affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ri-Hua Xie
- Department of Nursing, General Practice Center Nanhai Hospital, Southern Medical University, Guangzhou, PR China.
| | - Shi Wu Wen
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada.
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9
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Taverne SB, Bonouvrie DS, Uittenbogaart M, Luijten AA, Niemarkt HJ, van Laar JO, van Dielen FM, Leclercq WK. Guidelines Regarding Management of a Surgical Emergency During Pregnancy After Bariatric Surgery. Obes Surg 2019; 30:1126-1127. [PMID: 31848985 DOI: 10.1007/s11695-019-04325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sophie Bm Taverne
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands.,Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniëlle S Bonouvrie
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | | | - Arijan Apm Luijten
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | - Hendrik J Niemarkt
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Judith Oeh van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Wouter Kg Leclercq
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands.
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Effect of the closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a prospective study. Surg Obes Relat Dis 2019; 15:1903-1907. [DOI: 10.1016/j.soard.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/30/2019] [Accepted: 08/03/2019] [Indexed: 11/23/2022]
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11
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Petrucciani N, Ciangura C, Debs T, Ducarme G, Calabrese D, Gugenheim J. Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group. Surg Obes Relat Dis 2019; 16:312-331. [PMID: 31837948 DOI: 10.1016/j.soard.2019.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/14/2019] [Accepted: 10/22/2019] [Indexed: 12/29/2022]
Abstract
Considering the large and increasing population of women of childbearing age with history of bariatric surgery, surgical complications of bariatric surgery during pregnancy may become more frequent in the future. The aim of this study was to analyze the clinical presentation, diagnostic procedures, and treatment of surgical complications of bariatric surgery during pregnancies. A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines to identify all studies published up to and including December 2018 that included women with previous bariatric surgery undergoing emergency surgery during pregnancy. Sixty-eight studies were selected, including 120 women with previous bariatric surgery undergoing emergency surgery during pregnancy. Fifty cases were reported as case reports and 70 in case series. Included patients had previous history of Roux-en-Y gastric bypass (n = 99), laparoscopic adjustable gastric banding (n = 17), Scopinaro procedure (n = 2), vertical banded gastroplasty (n = 1), or one-anastomosis gastric bypass (n = 1). Final diagnosis in 50 case reports was internal hernia in 26 cases, bowel intussusception in 10, intestinal obstruction in 2, laparoscopic adjustable gastric banding slippage in 3, bowel volvulus in 3, gastric or jejunal perforation in 2, and other complications in 4 cases. Maternal and fetal death occurred in 3 (2.5%) and 9 cases (7.5%), respectively. In the case series, the majority of women were operated for internal hernia and laparoscopic adjustable gastric banding slippage. Surgical complications of previous bariatric surgery during pregnancy have potentially severe outcomes. Availability of multidisciplinary expertise, including bariatric/digestive surgeons, and education of healthcare providers and women on clinical signs that require urgent surgical examination are recommended in this setting. Prompt diagnosis is fundamental and based on clinical and laboratory findings and on radiologic examinations if needed, including computed tomography scan or magnetic resonance if available. Rapid surgical exploration is mandatory in case of high clinical and/or radiologic suspicion.
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Affiliation(s)
- Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France; Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Cecile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Nutrition, Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Digestive Surgery Department, Sorbonne Paris Cité Diderot, Colombes, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
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12
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Day M, Duke D. Petersen's Hernia Complicating Pregnancy after Laparoscopic Roux-en-Y Gastric Bypass. Am Surg 2019. [DOI: 10.1177/000313481908500814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Melissa Day
- Conemaugh Memorial Medical Center Johnstown, Pennsylvania
| | - D'Arcy Duke
- Conemaugh Memorial Medical Center Johnstown, Pennsylvania
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13
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Dave DM, Clarke KO, Manicone JA, Kopelan AM, Saber AA. Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15:1633-1640. [PMID: 31378635 DOI: 10.1016/j.soard.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/27/2022]
Abstract
Improved fertility following a Roux-en-Y gastric bypass (RYGB) can lead to pregnancy and increase the risk of internal herniation. A developing fetus and symptoms of pregnancy can mask the diagnosis and delay intervention, leading to deleterious maternal and fetal consequences. The aim of this systematic review is to summarize the literature regarding internal hernias during pregnancy, their management, and patient outcomes. A comprehensive literature search was undertaken on PubMed and Google Scholar to identify cases of internal hernias presenting during pregnancy after RYGB. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for eligibility and inclusion of articles. Twenty-seven articles, with a total of 59 patients, regarding internal herniation during pregnancy after RYGB were identified. Epigastric pain and nausea and vomiting was the most common presentation. Regardless of orientation of the Roux limb and despite previous closure of mesenteric defects, internal herniation can still occur. A triad of epigastric pain, pregnancy, and a history of RYGB should be a red flag for clinicians to consider internal hernias as a top differential diagnosis. Prompt bariatric consultation and rapid intervention will improve maternal and fetal outcomes.
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Affiliation(s)
- Devangi M Dave
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey; St. George's University School of Medicine, Grenada, West Indies
| | - Kevin O Clarke
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - John A Manicone
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - Adam M Kopelan
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - Alan A Saber
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey.
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14
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Fedorka PN, Murali SB, Rajaratnam DR. Abdominal Pain and Vomiting in a Pregnant Woman Who Has Had a Gastric Bypass Procedure. JAMA 2019; 321:998-999. [PMID: 30785600 DOI: 10.1001/jama.2017.18946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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Pregnancy As a Risk Factor for Small Bowel Obstruction After Laparoscopic Gastric Bypass Surgery. Ann Surg 2018; 272:125-129. [DOI: 10.1097/sla.0000000000003163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
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Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Stopp T, Falcone V, Feichtinger M, Göbl C. Fertility, Pregnancy and Lactation After Bariatric Surgery - a Consensus Statement from the OEGGG. Geburtshilfe Frauenheilkd 2018; 78:1207-1211. [PMID: 30655646 PMCID: PMC6294640 DOI: 10.1055/a-0706-7578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery is recommended when other weight loss interventions, such as lifestyle modification or medications, have failed. A considerable number of women undergoing bariatric surgery are of childbearing age; hence, it is necessary to be aware of the effects of bariatric surgery on pregnancy for managing these patients. Although bariatric surgery is associated with positive effects on cardiovascular and metabolic parameters, side effects such as anaemia, the risk of developing internal hernia, altered glucose metabolism and the risk of small for gestational age offspring have to be considered. Pregnant women with a history of gastric bypass should not undergo the oral glucose tolerance test (OGTT) due to the high risk of hypoglycaemia. There are no contraindications for vaginal delivery and breastfeeding. This paper has been published as a consensus statement by the Austrian Society of Gynaecology and Obstetrics (OEGGG).
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Affiliation(s)
- Tina Stopp
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | - Veronica Falcone
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | | | - Christian Göbl
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
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18
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Harreiter J, Schindler K, Bancher-Todesca D, Göbl C, Langer F, Prager G, Gessl A, Leutner M, Ludvik B, Luger A, Kautzky-Willer A, Krebs M. Management of Pregnant Women after Bariatric Surgery. J Obes 2018; 2018:4587064. [PMID: 29973985 PMCID: PMC6008727 DOI: 10.1155/2018/4587064] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/29/2018] [Indexed: 02/07/2023] Open
Abstract
The prevalence of obesity is growing worldwide, and strategies to overcome this epidemic need to be developed urgently. Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age. Weight loss influences fertility positively and can resolve hormonal imbalance. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12-24 months after surgery. As limited data of these suggestions exist, further evidence is urgently needed as well for weight gain in pregnancy. Oral glucose tolerance tests for the diagnosis of gestational diabetes mellitus (GDM) should not be performed after bariatric procedures due to potential hypoglycaemic adverse events and high variability of glucose levels after glucose load. This challenges the utility of the usual diagnostic criteria for GDM in accurate prediction of complications. Furthermore, recommendations on essential nutrient supplementation in pregnancy and lactation in women after bariatric surgery are scarce. In addition, nutritional deficiencies or daily intake recommendations in pregnant women after bariatric surgery are not well investigated. This review summarizes current evidence, proposes clinical recommendations in pregnant women after bariatric surgery, and highlights areas of lack of evidence and the resulting urgent need for more clinical investigations.
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Affiliation(s)
- Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christian Göbl
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Felix Langer
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Gerhard Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Alois Gessl
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Michael Leutner
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
- Medizinische Abteilung mit Endokrinologie, Diabetologie, Nephrologie, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
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Kannan U, Gupta R, Gilchrist BF, Kella VN. Laparoscopic management of an internal hernia in a pregnant woman with Roux-en-Y gastric bypass. BMJ Case Rep 2018; 2018:bcr-2017-221979. [PMID: 29674396 DOI: 10.1136/bcr-2017-221979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal-fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain. She had a history of laparoscopic Roux-en-Y gastric bypass performed 3 years earlier. The clinical examination was remarkable for epigastric pain and tenderness. The vital signs and laboratory examinations were unremarkable. The CT scan was suggestive of an internal hernia. On an exploratory laparoscopy, the distal common small bowel was found to be herniating through the jejunojejunostomy mesenteric defect, causing intestinal obstruction with dilatation of the Roux limb and the biliopancreatic limb. The internal hernia was reduced, and no bowel resection was required. The mesenteric defect was closed with 3-0 silk sutures in a continuous fashion. The patient was discharged after 3 days and delivered a healthy baby at 40 weeks of gestation.
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Affiliation(s)
| | - Ranjan Gupta
- General Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA
| | - Brian F Gilchrist
- General Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA
| | - Venkata N Kella
- General Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA
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20
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Abstract
OBJECTIVE The aim of the present study was to describe the risk of internal herniation (IH) and the obstetric outcome in pregnant women with Roux-en-Y gastric bypass (RYGB) and episodes of upper abdominal pain. METHODS The cohort included 133 women with RYGB: 94 with 113 pregnancies, from the local area referred for routine antenatal care (local cohort) and 39 with 40 pregnancies referred from other hospitals for specialist consultation due to RYGB. RYGB was mainly performed without closure of the mesenteric defects. Data collected from medical records were episodes of upper abdominal pain, pregestational and gestational abdominal surgery and pregnancy outcome. The risk of upper abdominal pain was estimated in the local cohort. Surgical intervention, IH and obstetric outcome according to pain were evaluated for 139 pregnancies with delivery of a singleton after 24 weeks of gestation (birth cohort). RESULTS Upper abdominal pain complicated 42/113 (37.2 %) pregnancies in the local cohort and 11 women (9.7 %) had IH. In the birth cohort, upper abdominal pain complicated 64/139 (46.0 %) pregnancies; surgery was performed in 30/64 (46.9 %), and IH diagnosed in 21/64 (32.8 %). The median gestational age at onset of pain was 25 + 3 weeks. Women reporting abdominal pain had a higher risk of preterm birth (n = 14/64 vs. 1/75, p < 0.005), lower median gestational length (269 vs. 278 days, p < 0.005) and lower median birth weight (3018 vs. 3281 g, p = 0.002) compared to women without abdominal pain. CONCLUSIONS Upper abdominal pain during pregnancy is frequent among women with Roux-en-Y gastric bypass, is often due to IH and is associated with adverse pregnancy outcome.
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21
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Rare Cause of Small Bowel Ischemia During Pregnancy After Roux-en-Y Gastric Bypass. Obes Surg 2017; 27:1879-1881. [PMID: 28389845 DOI: 10.1007/s11695-017-2676-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Nimeri A, Maasher A, Al Shaban T. Efferent limb obstruction and unexpected perforated marginal ulcer in a pregnant patient after one anastomosis gastric bypass/mini gastric bypass. Surg Obes Relat Dis 2017; 13:713-715. [DOI: 10.1016/j.soard.2017.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 01/26/2023]
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González I, Lecube A, Rubio MÁ, García-Luna PP. Pregnancy after bariatric surgery: improving outcomes for mother and child. Int J Womens Health 2016; 8:721-729. [PMID: 28008286 PMCID: PMC5167470 DOI: 10.2147/ijwh.s99970] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS). These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy.
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Affiliation(s)
- Irene González
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida Biomedicine Research Institute (IRB-Lleida), CIBER in Diabetes and Associated Metabolic Disorders (CIBERDEM), Lleida University, Lleida, Spain
| | - Miguel Ángel Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain
| | - Pedro Pablo García-Luna
- Endocrinology and Nutrition Department, Hospitales Universitarios Virgen del Rocío, Seville, Spain
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24
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Murad-Junior AJ, Scheibe CL, Campelo GP, de Lima RC, Murad LMMRP, dos Santos EPR, Ramos AC, Valadão JA. FIXING JEJUNAL MANEUVER TO PREVENT PETERSEN HERNIA IN GASTRIC BYPASS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28 Suppl 1:69-72. [PMID: 26537279 PMCID: PMC4795312 DOI: 10.1590/s0102-6720201500s100019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
Background : Among Roux-en-Y gastric bypass complications is the occurrence of intestinal
obstruction by the appearance of internal hernias, which may occur in Petersen
space or the opening in mesenteric enteroenteroanastomosis. Aim : To evaluate the efficiency and safety in performing a fixing jejunal maneuver in
the transverse mesocolon to prevent internal hernia formation in Petersen space.
Method : Two surgical points between the jejunum and the transverse mesocolon, being 5 cm
and 10 cm from duodenojejunal angle are made. In all patients was left Petersen
space open and closing the opening of the mesenteric enteroenteroanastomosis. Results : Among 52 operated patients, 35 were women (67.3%). The age ranged 18-63 years,
mean 39.2 years. BMI ranged from 35 to 56 kg/m2 (mean 40.5
kg/m2). Mean follow-up was 15.1 months (12-18 months). The operative
time ranged from 68-138 min. There were no intraoperative complications, and there
were no major postoperative complications and no reoperations. The hospital stay
ranged from 2-3 days. During the follow-up, no one patient developed suspect
clinical presentation of internal hernia. Follow-up in nine patients (17.3%)
showed asymptomatic cholelithiasis and underwent elective laparoscopic
cholecystectomy. During these procedures were verified the Petersen space and
jejunal fixation. In all nine, there was no herniation of the jejunum to the right
side in Petersen space. Conclusion : The fixation of the first part of the jejunum to left side of the transverse
mesocolon is safe and effective to prevent internal Petersen hernia in RYGB
postoperatively in the short and medium term. It may be interesting alternative to
closing the Petersen space.
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25
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de Raaff CAL, Eshuis WJ, van Wagensveld BA, van Veen RN. Complications of banded laparoscopic Roux-en-Y gastric bypass in a 33-week pregnant woman. J Surg Case Rep 2016; 2016:rjw137. [PMID: 27562576 PMCID: PMC4999040 DOI: 10.1093/jscr/rjw137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Women desiring pregnancy might fail to conceive due to their obesity. Bariatric surgery has shown to reduce this infertility up to 58% and is therefore considered a successful strategy for morbidly obese infertile women. Nevertheless, when pregnancy has succeeded, surgery-related complications might occur. Banded laparoscopic Roux-en-Y gastric bypass (B-LRYGB) is a relatively new technique in which a band is placed around the small gastric pouch. We report a case of a 30-year-old woman who succeeded to become pregnant after weight loss due to B-LRYGB, but presented with acute abdominal pain in Week 33 of her pregnancy.
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Affiliation(s)
- Christel A L de Raaff
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands
| | - Wietse J Eshuis
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands
| | - Bart A van Wagensveld
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands
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