Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass.

Area of Science:

• Bariatric Surgery
• Minimally Invasive Surgery
• Surgical Complications

Background:

• Internal hernia (IH) is a known complication after Roux-en-Y gastric bypass (RYGB).
• There is ongoing debate regarding the necessity and efficacy of closing mesenteric defects to prevent IH.
• Previous studies report variable rates of IH and conflicting data on closure effectiveness.

Purpose of the Study:

• To evaluate the impact of closing the jejunojejunal anastomotic mesenteric defect on the incidence of internal hernia (IH) after RYGB.
• To compare IH rates in patients before and after the implementation of routine mesenteric defect closure.

Main Methods:

• Retrospective review of 2079 RYGB procedures performed between 2001 and 2009.
• Comparison of IH incidence between two groups: pre-September 2003 (defects not closed) and post-September 2003 (defects closed with permanent suture).
• Chi-square analysis was used to determine statistical significance.

Main Results:

• A significant reduction in IH incidence was observed after implementing mesenteric defect closure (1.0% vs 10%, P <.001).
• In the group with closed defects, only 1 IH occurred (at Petersen's defect), compared to 37 IHs in the group with open defects.
• The incidence of IH at the jejunojejunal mesenteric defect dropped from 10% to 0% after closure.

Conclusions:

• Routine closure of mesenteric defects during RYGB significantly decreases the incidence of internal hernias.
• Internal hernias can manifest acutely with obstruction or chronically with intermittent pain.
• Closing mesenteric defects is a crucial step in preventing IH after RYGB.