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Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial.

Ulysses Rosas1, Shusmita Ahmed, Natalia Leva

  • 1Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA.

Surgical Endoscopy
|December 7, 2014
PubMed
Summary

Closing mesenteric defects after laparoscopic Roux-en-Y gastric bypass (LRYGB) did not significantly reduce internal hernia or complication rates. A high suspicion for internal hernias is still recommended post-LRYGB.

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Area of Science:

  • Bariatric Surgery
  • Minimally Invasive Surgery
  • Surgical Complications

Background:

  • Internal herniation is a known complication after laparoscopic Roux-en-Y gastric bypass (LRYGB).
  • Previous research suggests closing mesenteric defects may lower internal hernia incidence, but evidence remains debated.
  • This study investigates the necessity of jejunal mesenteric defect closure in LRYGB.

Purpose of the Study:

  • To determine if jejunal mesenteric defect closure impacts internal hernia rates after LRYGB.
  • To evaluate the effect of mesenteric defect closure on other post-operative complications.
  • To assess the influence on patient outcomes including quality of life and weight loss.

Main Methods:

  • A randomized controlled trial involving 105 patients undergoing laparoscopic antecolic RYGB.
  • Patients were divided into two groups: closed mesenteric defect (n=50) and open mesenteric defect (n=55).
  • Outcomes measured included internal hernia incidence, complications, readmissions, reoperations, GI QoL scores, and %EWL over a 3-year follow-up.

Main Results:

  • No significant differences were observed in BMI decrease or %EWL between the groups at 12 months.
  • The incidence of internal hernias and general complications was similar in both the closed and open defect groups.
  • Both groups reported improved GI QoL scores, with no significant between-group differences at 12 months.

Conclusions:

  • Jejunal mesenteric defect closure or non-closure yields comparable rates of internal hernias and complications following LRYGB.
  • Maintaining a high index of suspicion for internal hernias is crucial for patients undergoing LRYGB, regardless of defect closure.
  • The study suggests that routine closure of mesenteric defects may not be essential for preventing internal hernias post-LRYGB.