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According to the most recent data from the Centers for Disease Control & Prevention, more than one-third of the U.S. adult population is obese. Obesity is associated with numerous chronic health conditions, such as diabetes, hypertension, coronary artery disease, and even certain types of cancer. Bariatric surgery has been shown to be more effective than dietary, behavioral, or pharmacological interventions for weight loss. With increasing experience in laparoscopy and improved perioperative outcomes, bariatric procedures have gained in popularity amongst patients and referring providers alike. The Roux-en-Y gastric bypass (RYGB) is highly effective in reducing excess weight and curtailing the progression of obesity-related comorbidities. In fact, the RYGB is still widely regarded today as the gold standard in weight loss surgery. There are, however, a number of short-term and long-term sequelae that may occur in RYGB patients. Herein the authors present a focused discussion of intestinal complications associated with the RYGB. The clinical management of these intestinal complications is thoroughly discussed, based upon the most recent review of the literature as well as the authors' experience at an accredited bariatric center. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) was the most common bariatric procedure performed for obesity in the United States from 2004 to 2012, and complications are not uncommon. To our knowledge, diaphragmatic hernia is not a known complication after RYGB; however, it is a potentially fatal complication with increased risk for ischemia and perforation of the incarcerated contents. Here, we present the case of a middle-aged women who presented years after RYGB surgery without the typical signs and symptoms of internal herniation or stricture. The patient was diagnosed with a diaphragmatic hernia using imaging, and the diagnosis was confirmed with exploratory laparoscopy. This case illustrates the importance of maintaining a high level of suspicion of diaphragmatic hernia in patients presenting with acute or recurrent atypical gastrointestinal and respiratory symptoms many years after open undivided RYGB. It also demonstrates the need for early radiological evaluation and involvement with the bariatric surgery team followed by prompt surgical intervention by laparoscopy or laparotomy. [ABSTRACT FROM AUTHOR]

We present a case of internal hernia after laparoscopic Roux-en-Y gastric bypass (RYGB) for morbid obesity associated with the presence of chylous ascites. Internal hernia is one of the most common complications after laparoscopic RYGB, and its incidence has been found to be decreased with antecolic/antegastric Roux limb positioning and closure of all mesenteric defects. Chylous ascites is a rare finding during exploration for internal hernia or small bowel strangulation from any cause, but it is thought to be secondary to chronic obstruction of the low flow lymphatic channels with subsequent leakage of chyle into the peritoneum without obstruction of high flow venous and arterial vessels. [ABSTRACT FROM AUTHOR]