Incarcerated Diaphragmatic Hernias After Roux-en-Y Gastric Bypass

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common operations performed for morbid obesity. Some of the known surgical complications include anastomotic leaks and small bowel obstructions due to internal hernias. Diaphragmatic hernias are common in the general population, and repair of symptomatic hernias is generally recommended. Diaphragmatic hernia after a prior LRYGB is markedly less common. Diaphragmatic hernias can occur via a hiatal defect or rarely a parahiatal defect that is found lateral to the hiatus. We present two cases of incarcerated diaphragmatic hernias after a LRYGB with vastly different presentations. The first patient presented with a giant defect containing incarcerated jejunum after a prior LRYGB. The second patient presented with a parahiatal defect with an incarcerated remnant stomach. The first patient was successfully managed laparoscopically by reinforcing the defect with a mesh after defect closure. The second patient required an open operation due to the inability to reduce the tightly incarcerated stomach and defect approximated with sutures without the need for mesh reinforcement. Both patients did well postoperatively and remain symptom-free.