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01-05-2020 | Original Contributions

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

Authors: Dimitrios E. Magouliotis, George Tzovaras, Vasiliki S. Tasiopoulou, Grigorios Christodoulidis, Dimitris Zacharoulis

Published in: Obesity Surgery | Issue 5/2020

Abstract

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.

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Colquit JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2:CD003641.

Magouliotis DE, Tasiopoulou VS, Sioka E, et al. Impact of bariatric surgery on metabolic and gut microbiota profile: a systematic review and meta-analysis. Obes Surg. 2017; https://doi.org/10.1007/s11695-017-2595-8.CrossRefPubMed

Saber AA, Elgamal MH, McLeod MK. Bariatric surgery: the past, present, and future. Obes Surg. 2008;18:121–8.CrossRefPubMed

Magouliotis DE, Tasiopoulou VS, Svokos AA, et al. Roux-en-Y gastric bypass versus sleeve gastrectomy as revisional procedure after adjustable gastric band: a systematic review and meta-analysis. Obes Surg. 2017;27:1365. https://doi.org/10.1007/s11695-017-2644-3.CrossRefPubMed

Abasbassi M, Pottel H, Deylgat B, et al. 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;21:1822–7.CrossRefPubMed

Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7:516–25.CrossRefPubMed

Aghajani E, Jacobsen HJ, Nergaard BJ, et al. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg. 2012;16:641–5.CrossRefPubMed

Martin MJ. Comment on: Impact of complete mesenteric closure on small bowel obstruction and internal mesenteric hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9:854–5.CrossRefPubMed

Geubbels N, Lijftogt N, Fiocco M, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102:451–60.CrossRefPubMed

10.

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.CrossRefPubMedPubMedCentral

11.

Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011 Available from www.cochrane-handbook.org

12.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRefPubMed

13.

Egger M, Davey Smith G, Schneider M. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.CrossRefPubMedPubMedCentral

14.

Aghajani E, Nergaard BJ, Leifson BG, et al. The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017;31(9):3743–8. https://doi.org/10.1007/s00464-017-5415-2.CrossRefPubMedPubMedCentral

15.

Amor IB, Kassir R, Debs T, et al. Impact of mesenteric defect closure during laparoscopic Roux-en-Y gastric bypass (LRYGB): a retrospective study for a total of 2093 LRYGB. Obes Surg. 2019;29:3342–7. https://doi.org/10.1007/s11695-019-04000-5.CrossRefPubMed

16.

Blockhuys M, Gypen B, Heyman S, et al. Internal hernia after laparoscopic gastric bypass: effect of closure of the Petersen defect - single-center study. Obes Surg. 2019;29(1):70–5. https://doi.org/10.1007/s11695-018-3472-9.CrossRefPubMed

17.

Chowbey P, Baijal M, Kantharia NS, et al. Mesenteric defect closure decreases the incidence of internal hernias following laparoscopic Roux-en-Y gastric bypass: a retrospective cohort study. Obes Surg. 2016;26(9):2029–34. https://doi.org/10.1007/s11695-016-2049-8.CrossRefPubMed

18.

de la Cruz-Muñoz N, Cabrera JC, Cuesta M, et al. Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7(2):176–80. https://doi.org/10.1016/j.soard.2010.10.003.CrossRefPubMed

19.

Lopera CA, Vergnaud JP, Cabrera LF, et al. 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):1077–81. https://doi.org/10.1007/s10029-018-1814-0.CrossRefPubMed

20.

Rodríguez A, Mosti M, Sierra M, et al. 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. https://doi.org/10.1007/s11695-010-0164-5.CrossRefPubMed

21.

Rosas U, Ahmed S, Leva N, et al. Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. Surg Endosc. 2015;29(9):2486–90. https://doi.org/10.1007/s00464-014-3970-3.CrossRefPubMed

22.

Stenberg E, Szabo E, Ågren G, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. Lancet. 2016;387(10026):1397–404. https://doi.org/10.1016/S0140-6736(15)01126-5.CrossRefPubMed

23.

Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019;29:782–95. https://doi.org/10.1007/s11695-018-3593-1.CrossRefPubMed

24.

Garza Jr E, Kuhn J, Arnold D, et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2004;188:796–800.CrossRefPubMed

25.

Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350–4.CrossRefPubMed

26.

Jacobsen H, Dalenback J, Ekelund M, et al. Tensile strength after closure of mesenteric gaps in laparoscopic gastric bypass: three techniques tested in a porcine model. Obes Surg. 2013;23:320–4.CrossRefPubMed

27.

Al Harakeh AB, Kallies KJ, Borgert AJ, et al. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2016;12(1):194–8. https://doi.org/10.1016/j.soard.2015.02.004.CrossRefPubMed

28.

Brolin RE. The antiobstruction stitch in stapled Roux-en-Y enteroenterostomy. Am J Surg. 1995;169:355–7.CrossRefPubMed

29.

Ekelund M. Systematic review and meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102:460–1.CrossRefPubMed

Title: Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: a Meta-Analysis
Authors: Dimitrios E. Magouliotis
George Tzovaras
Vasiliki S. Tasiopoulou
Grigorios Christodoulidis
Dimitris Zacharoulis
Publication date: 01-05-2020
Publisher: Springer US
Published in: Obesity Surgery / Issue 5/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04418-2

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Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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