Comparison between the mesenteric fixation method (MEFIX) and conventional methods at preventing the occurrence of...

Area of Science:

• Gastrointestinal surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Petersen's hernia is a complication following Billroth-II (B-II) or Roux-en-Y (REY) anastomosis.
• Defect closure is a key strategy to prevent Petersen's hernia.
• Laparoscopic or robotic gastrectomy increases the risk of internal hernias.

Purpose of the Study:

• To compare the incidence of severe bowel obstruction (Clavien-Dindo grade III) caused by Petersen's hernia.
• To evaluate the efficacy of the mesenteric fixation (MEFIX) method versus conventional closure techniques.
• To assess postoperative complications associated with different Petersen's defect closure methods.

Main Methods:

• Prospective, single-blind, non-inferiority randomized controlled multicenter trial.
• Inclusion of patients with gastric cancer (stages I-III) undergoing B-II or REY anastomosis after laparoscopic or robotic gastrectomy.
• Random assignment to either conventional Petersen's defect closure or the MEFIX method.

Main Results:

• Primary endpoint: number of patients requiring surgery for Petersen's hernia-related bowel obstruction within 3 years.
• Secondary endpoints to assess surgical site infections, intra-abdominal fluid collection, and other complications.
• Data analysis to determine non-inferiority of the MEFIX method.

Conclusions:

• The MEFIX method is expected to demonstrate non-inferiority to conventional closure for preventing severe bowel obstruction.
• This approach aims for a quicker and simpler closure of Petersen's defects.
• The study anticipates no increase in postoperative complications with the MEFIX technique.