Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?
Bariatric surgery
Gastric bypass
Internal hernia
Mesenteric defects
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
05
10
2020
accepted:
21
04
2021
pubmed:
23
5
2021
medline:
2
10
2021
entrez:
22
5
2021
Statut:
ppublish
Résumé
Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, with 493 patients without jejunal mesenteric defect closure and 292 patients with closure by non-absorbable suture, and a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Through primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5 to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery reduced the rate of IH from 5.3 to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. The closure of the jejunal mesenteric defect by non-absorbable suture may reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, particularly in patients with good weight loss. The Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.
Identifiants
pubmed: 34021417
doi: 10.1007/s00423-021-02180-2
pii: 10.1007/s00423-021-02180-2
pmc: PMC8481144
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1831-1838Informations de copyright
© 2021. The Author(s).
Références
Obes Surg. 2019 Apr;29(4):1229-1235
pubmed: 30675687
Obes Surg. 2015 Oct;25(10):1822-32
pubmed: 25835983
Br J Surg. 2015 Apr;102(5):451-60
pubmed: 25708572
Langenbecks Arch Surg. 2018 Jun;403(4):481-486
pubmed: 29858618
J Gastrointest Surg. 2012 Mar;16(3):641-5
pubmed: 22125176
Obes Surg. 2016 Sep;26(9):2029-2034
pubmed: 26757920
Langenbecks Arch Surg. 2016 May;401(3):307-13
pubmed: 27001683
Obes Surg. 2011 Dec;21(12):1822-7
pubmed: 21656166
Surg Obes Relat Dis. 2015 Mar-Apr;11(2):459-64
pubmed: 25813753
JAMA. 2015 Jan 6;313(1):62-70
pubmed: 25562267
Obes Surg. 2018 Dec;28(12):3783-3794
pubmed: 30121858
Ann Surg. 2003 Oct;238(4):467-84; discussion 84-5
pubmed: 14530719
JAMA. 2014 Jun 11;311(22):2297-304
pubmed: 24915261
Surg Obes Relat Dis. 2011 Jul-Aug;7(4):516-25
pubmed: 21333610
N Engl J Med. 2017 Feb 16;376(7):641-651
pubmed: 28199805
Surg Endosc. 2017 Sep;31(9):3743-3748
pubmed: 28205037
JAMA. 2019 Oct 1;322(13):1271-1282
pubmed: 31475297
Obes Surg. 1996 Dec;6(6):500-504
pubmed: 10729899
Surg Endosc. 1996 Jun;10(6):636-8
pubmed: 8662402
Obes Surg. 2019 Jan;29(1):70-75
pubmed: 30167987
Lancet. 2016 Apr 2;387(10026):1397-1404
pubmed: 26895675
Obes Surg. 2019 Oct;29(10):3342-3347
pubmed: 31175558