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. 2022 Jun 1;275(6):1137-1142.
doi: 10.1097/SLA.0000000000004370. Epub 2020 Oct 14.

Development and Validation of a Predictive Model for Internal Hernia After Roux-en-Y Gastric Bypass in a Multicentric Retrospective Cohort: The Swirl, Weight Excess Loss, Liquid Score

Guillaume Giudicelli  1   2 , Pierre-Alexandre Poletti  3 , Alexandra Platon  4 , Jacques Marescaux  4 , Michel Vix  5 , Michele Diana  4   5   2 , Alfonso Lapergola  4 , Marc Worreth  2 , Alend Saadi  2 , Aurélie Bugmann  2 , Philippe Morel  1 , Christian Toso  1 , Stefan Mönig  1 , Monika E Hagen  1 , Minoa K Jung  1
Affiliations

Development and Validation of a Predictive Model for Internal Hernia After Roux-en-Y Gastric Bypass in a Multicentric Retrospective Cohort: The Swirl, Weight Excess Loss, Liquid Score

Guillaume Giudicelli et al. Ann Surg. .

Abstract

Objective: The aim of this study was to develop and validate a prediction score for internal hernia (IH) after Roux-en-Y gastric bypass (RYGB).

Summary background data: The clinical diagnosis of IH is challenging. A sensitivity of 63% to 92% was reported for computed tomography (CT).

Methods: Consecutive patients admitted for abdominal pain after RYGB and undergoing CT and surgical exploration were included retrospectively. Potential clinical predictors and radiological signs of IH were entered in binary logistic regression analysis to determine a predictive score of surgically confirmed IH in the Geneva training set (January 2006-December 2014), and validated in 3 centers, Geneva (January 2015-December 2017) and Neuchâtel and Strasbourg (January 2012-December 2017).

Results: Two hundred twenty-eight patients were included, 80 of whom (35.5%) had surgically confirmed IH, 38 (16.6%) had a negative laparoscopy, and 110 (48.2%) had an alternate diagnosis. In the training set of 61 patients, excess body weight loss >95% (odds ratio [OR] 6.73, 95% confidence interval [CI]: 1.13-39.96), swirl sign (OR 8.93, 95% CI: 2.30-34.70), and free liquid (OR 4.53, 95% CI: 1.08-19.0) were independent predictors of IH. Area under the curve (AUC) of the score was 0.799. In the validation set of 167 patients, AUC was 0.846. A score ≥2 was associated with an IH incidence of 60.7% (34/56), and 5.3% (3/56) had a negative laparoscopy.

Conclusions: The score could be incorporated in the clinical setting. To reduce the risk of delayed IH diagnosis, emergency explorative laparoscopy in patients with a score ≥ 2 should be considered.

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Conflict of interest statement

Conflicts of interest and source of funding: JM is the president of the IRCAD institute which is partly funded by Karl Storz and Medtronic; CT received personal fees Intuitive Surgical Inc, Ethicon Inc. and Verb Sugical, outside this project; MH received personal fees and nonfinancial support form Intuitive Surgical Inc., Quantgene Inc., Ethicon Inc. and Verb Surgical, outside this project; MJ received personal fees from Intuitive Surgical Inc., Johnson and Johnson Incl., outside this project; for the remaining authors none were declared.

References

    1. Geubbels N, Lijftogt N, Fiocco M, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg 2015; 102:451–460.
    1. Al-Mansour MR, Mundy R, Canoy JM, et al. Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass. Obes Surg 2015; 25:2106–2111.
    1. Farukhi MA, Mattingly MS, Clapp B, et al. CT scan reliability in detecting internal hernia after gastric bypass. JSLS 2017; 21:e2017.00054.
    1. Alsulaimy M, Punchai S, Ali FA, et al. The utility of diagnostic laparoscopy in post-bariatric surgery patients with chronic abdominal pain of unknown etiology. Obes Surg 2017; 27:1924–1928.
    1. Facchiano E, Leuratti L, Veltri M, et al. Laparoscopic management of internal hernia after Roux-en-Y gastric bypass. Obes Surg 2016; 26:1363–1365.

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