As you well know, the valuable health benefits of weight loss surgery have been proven time and time again. However, there are potential drawbacks to consider. Now, new research suggests that morbidly obese patients undergoing bariatric procedures may face an increased risk of developing a hernia.

A ground-breaking study explored the connection between undergoing rapid and excessive weight loss and the development of internal hernias. This condition occurs when abdominal structures (like the intestines), shift from their normal location in the abdominal cavity. Internal hernias, which may result in harmful bowel obstructions, can be corrected surgically.

When to Consider A Surgical Consultation

The study’s findings were presented at the 2008 Clinical Congress of the American College of Surgeons. The study focused on 786 patients undergoing laparoscopic gastric bypass procedures from 2002-2007.  About 200,00 morbidly obese men and women undergo this procedure annually. Among the study’s results, it was shown that:

• 24 patients developed internal hernia
• 19 patients experienced weight loss more than 125% greater than expected one or more times after the procedure
• Post-surgery, patients were expected to lose 40% of their excess weight after three months; 60% after six months; 75% after nine months; and 85% after 12 months

In light of these findings, patients who have undergone bariatric surgery are advised to go for a surgical consult if they lose more weight than expected. In addition, they should receive consults if they experience intermittent or persistent abdominal pain.

“It’s our job to educate general surgeons who see patients who have abdominal pain and have lost a tremendous amount of weight in a quicker than expected period of time to be on the lookout for internal hernia as a possible cause of the symptoms,” says Eric S. Bour, MD, Bariatric Medical Director of Hillcrest Memorial Hospital, Simpsonville, SC. “We caution patients if they start to develop episodes of abdominal pain or bilious vomiting that they should consult their surgeon and go through a workup.”

According to the researchers, internal hernia is a little-explored condition. Currently there’s no method for predicting if patients are at risk for its development. It’s estimated that 4-10% of those who have undergone laparoscopic gastric bypass procedures develop internal hernias. These patients may be more likely to develop internal hernias due to their excessive weight loss. Surgeons believe that the weight loss causes the bowel to slip through the openings much more easily. “The theory is that in those periods of profound weight loss defects open up more readily,” says Bour.

To correct an internal hernia, surgeons transfer bowel’s herniated portion back to its proper position. Then, they close the defects with sutures to prevent serious complications. These may include the small bowel’s strangulation and incarceration, as well as part of the bowel being caught within the hernia.