Article: Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: a Meta-Analysis

Introduction: The purpose of the current study was to review the available literature on morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to assess the clinical outcomes of the routine closure of the mesenteric defects.

Methods: A literature search was performed in PubMed, Cochrane library, and Scopus, in accordance with the PRISMA guidelines.

Results: Nine studies met the inclusion criteria. A total of 16,520 patients were incorporated with a mean follow-up ranging from 34 to 120 months. The closure of the mesenteric defects was associated with a lower incidence of internal hernias (odds ratio, 0.25 [95% confidence interval 0.20, 0.31]; p < 0.01), small bowel obstruction (SBO) (0.30 [0.17, 0.52]; p < 0.0001) and reoperations (0.28 [0.15, 0.52]; p < 0.001). Both approaches presented similar complication rates and % excess weight loss (%EWL).

Conclusion: The present meta-analysis is the best currently available evidence on the topic and supports the routine closure of the mesenteric defects.

Citing Articles

Analyzing the impact of surgical technique on intraoperative adverse events in laparoscopic Roux-en-Y gastric bypass surgery by video-based assessment.

Lavanchy J, Alapatt D, Sestini L, Kraljevic M, Nett P, Mutter D Surg Endosc. 2025; 39(3):2026-2036.

PMID: 39890612 PMC: 11870895. DOI: 10.1007/s00464-025-11557-z.

Comparative analysis of linear- and circular-stapled gastrojejunostomies in Roux-en-Y gastric bypass: a focus on postoperative morbidity using the comprehensive complication index.

Sadiku F, Alceste D, Serra M, Hehl S, Gero D, Thalheimer A Langenbecks Arch Surg. 2024; 409(1):120.

PMID: 38602565 PMC: 11009775. DOI: 10.1007/s00423-024-03303-1.

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.

Do all roads lead to Rome?: A retrospective analysis on surgical technique in Roux-en-Y gastric bypass.

Vu A, Chiang J, Qian Y, Tursunova N, Nha J, Ferzli G Surg Endosc. 2023; 37(9):7254-7263.

PMID: 37415013 DOI: 10.1007/s00464-023-10257-w.

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.

References

1.

HEWITT H, Sakamoto K . The comparative survival of clonogenic cells of a murine epithelioma after irradiation in mice breathing air, oxygen and carbon dioxide, or hyperbaric oxygen. Br J Radiol. 1971; 44(522):457-63. DOI: 10.1259/0007-1285-44-522-457. View

2.

Lopera C, Vergnaud J, Cabrera L, Sanchez S, Pedraza M, Vinck E . Preventative laparoscopic repair of Petersen's space following gastric bypass surgery reduces the incidence of Petersen's hernia: a comparative study. Hernia. 2018; 22(6):1077-1081. DOI: 10.1007/s10029-018-1814-0. View

3.

Rodriguez A, Mosti M, Sierra M, Perez-Johnson R, Flores S, Dominguez G . Small bowel obstruction after antecolic and antegastric laparoscopic Roux-en-Y gastric bypass: could the incidence be reduced?. Obes Surg. 2010; 20(10):1380-4. DOI: 10.1007/s11695-010-0164-5. View

4.

Rosas U, Ahmed S, Leva N, Garg T, Rivas H, Lau J . Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. Surg Endosc. 2014; 29(9):2486-90. DOI: 10.1007/s00464-014-3970-3. View

5.

Stenberg E, Szabo E, Agren G, Ottosson J, Marsk R, Lonroth H . Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. Lancet. 2016; 387(10026):1397-1404. DOI: 10.1016/S0140-6736(15)01126-5. View