Impact of Mesenteric Defect Closure During Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): a Retrospective Study for a Total of 2093 LRYGB

Overview

Journal Obes Surg

Date 2019 Jun 9

PMID 31175558

Citations 11

Authors

Imed Ben Amor

Radwan Kassir

Tarek Debs

Saud Aldeghaither

Niccolo Petrucciani

Marco Nunziante

Patrick Baque

Abdullah Almunifi

Jean Gugenheim

Affiliations

Soon will be listed here.

Abstract

Background: Internal hernia is a rare but a potentially fatal complication of laparoscopic Roux-En-Y gastric bypass (LRYGB). The aims of this study are to determine the impact of mesenteric defects closure on the incidence of internal hernia after LRYGB and to determine the symptoms, characteristics, and management of internal hernias after LRYGB.

Methods: A retrospective study for a total of 2093 LRYGB was carried out from 1998 to December 2013. Four hundred twenty-one patients were operated without closure of the mesenteric defects (group A). From January 2005 to December 2013, 1672 patients were operated with closure of the mesenteric defects at Petersen defect (PD) and at jejunojejunal anastomosis (J-J) defect (group B). The incidence of internal hernias was compared between the two periods.

Results: Out of the 2093 patients who underwent LRYGB, 20 patients (0.95%) developed a symptomatic internal hernia that required primary surgical intervention; 7 patients (1.66%) in group A all at J-J DEFECT versus 13 patients (0.78%) in (group B) 6 at (J-J DEFECT), 5 at PD, and 2 at PD, J-J DEFECT. This incidence was significantly lower in (group B) (p = 0.0021). The median interval between LRYGB and reoperation was 53 months in group A and 26 months in group B. A CT scan was performed in 8 patients, 40%, and showed signs of occlusion in all cases.

Conclusions: The closure of mesenteric defects during LRYGB is recommended because it is associated with a significant reduction in the incidence of internal hernia.

Citing Articles

Petersen's space hernia as an immediate complication in a patient undergoing gastric bypass: a case report.

Michel Macareno A, Cobos Roman J, Michel Esparza R, Gil Gamez J, Medina Estrada A, Esparza Estrada I J Surg Case Rep. 2024; 2024(9):rjae589.

PMID: 39329007 PMC: 11425907. DOI: 10.1093/jscr/rjae589.

Quality of stapled mesenteric defect closure influences the chance of reopening after laparoscopic Roux-en-Y gastric bypass surgery.

Bruinsma F, van der Burg S, El Adel S, Schouten R, Smeets S Updates Surg. 2024; 76(4):1405-1412.

PMID: 38332391 PMC: 11341638. DOI: 10.1007/s13304-024-01751-4.

Laparoscopic repair of internal hernia in one anastomosis gastric bypass (OAGB): a case report.

Al-Mulla A, Elgazzar M, Shalaby O J Surg Case Rep. 2023; 2023(12):rjad670.

PMID: 38111490 PMC: 10725789. DOI: 10.1093/jscr/rjad670.

Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis.

Muir D, Choi B, Clements C, Ratnasingham K, Irukulla S, Humadi S Obes Surg. 2023; 33(7):2229-2236.

PMID: 37162714 DOI: 10.1007/s11695-023-06597-0.

Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis.

Apostolou K, Lazaridis I, Kanavidis P, Triantafyllou M, Gkiala A, Alexandrou A Langenbecks Arch Surg. 2023; 408(1):49.

PMID: 36662172 DOI: 10.1007/s00423-023-02798-4.

References

Champion J, Williams M . Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003; 13(4):596-600. DOI: 10.1381/096089203322190808. View

Husain S, Ahmed A, Johnson J, Boss T, OMalley W . Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg. 2007; 142(10):988-93. DOI: 10.1001/archsurg.142.10.988. View

Higa K, Ho T, Boone K . Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003; 13(3):350-4. DOI: 10.1381/096089203765887642. View

Eckhauser A, Torquati A, Youssef Y, Kaiser J, Richards W . Internal hernia: postoperative complication of roux-en-Y gastric bypass surgery. Am Surg. 2006; 72(7):581-4. View

Coleman M, Awad Z, Pomp A, Gagner M . Laparoscopic closure of the Petersen mesenteric defect. Obes Surg. 2006; 16(6):770-2. DOI: 10.1381/096089206777346727. View

Obeid A, McNeal S, Breland M, Stahl R, Clements R, Grams J . Internal hernia after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2013; 18(2):250-5. DOI: 10.1007/s11605-013-2377-0. View

de la Cruz-Munoz N, Cabrera J, Cuesta M, Hartnett S, Rojas R . Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010; 7(2):176-80. DOI: 10.1016/j.soard.2010.10.003. View

Capella R, Iannace V, Capella J . Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg. 2006; 203(3):328-35. DOI: 10.1016/j.jamcollsurg.2006.05.301. View

Aghajani E, Jacobsen H, Nergaard B, Hedenbro J, Leifson B, Gislason H . Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg. 2011; 16(3):641-5. PMC: 3274684. DOI: 10.1007/s11605-011-1790-5. View

10.

Marema R, Perez M, Buffington C . Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries. Surg Endosc. 2005; 19(4):525-30. DOI: 10.1007/s00464-004-8907-9. View

11.

Calle E, Teras L, Thun M . Obesity and mortality. N Engl J Med. 2005; 353(20):2197-9. DOI: 10.1056/NEJM200511173532020. View

12.

Noria S, Grantcharov T . Biological effects of bariatric surgery on obesity-related comorbidities. Can J Surg. 2013; 56(1):47-57. PMC: 3569476. DOI: 10.1503/cjs.036111. View

13.

Ahmed A, Rickards G, Husain S, Johnson J, Boss T, OMalley W . Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007; 17(12):1563-6. DOI: 10.1007/s11695-007-9260-6. View

14.

Iannelli A, Buratti M, Novellas S, Dahman M, Amor I, Sejor E . Internal hernia as a complication of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007; 17(10):1283-6. DOI: 10.1007/s11695-007-9229-5. View

15.

Carmody B, DeMaria E, Jamal M, Johnson J, Carbonell A, Kellum J . Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006; 1(6):543-8. DOI: 10.1016/j.soard.2005.08.005. View

16.

Abasbassi M, Pottel H, Deylgat B, Vansteenkiste F, Van Rooy F, Devriendt D . Small bowel obstruction after antecolic antegastric laparoscopic Roux-en-Y gastric bypass without division of small bowel mesentery: a single-centre, 7-year review. Obes Surg. 2011; 21(12):1822-7. DOI: 10.1007/s11695-011-0462-6. View

17.

Nguyen N, Goldman C, Rosenquist C, Arango A, Cole C, Lee S . Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001; 234(3):279-89; discussion 289-91. PMC: 1422019. DOI: 10.1097/00000658-200109000-00002. View

18.

Nelson L, Gonzalez R, Haines K, Gallagher S, Murr M . Spectrum and treatment of small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006; 2(3):377-83, discussion 383. DOI: 10.1016/j.soard.2006.02.013. View

19.

Iannelli A, Facchiano E, Gugenheim J . Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006; 16(10):1265-71. DOI: 10.1381/096089206778663689. View

20.

Calle E, Rodriguez C, Walker-Thurmond K, Thun M . Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003; 348(17):1625-38. DOI: 10.1056/NEJMoa021423. View