Top

Obesity Surgery

Published in:

27-06-2022 | Recurrent Abdominal Pain | Original Contributions

Risk of Reopening of the Mesenteric Defects After Routine Closure in Laparoscopic Roux-en-Y Gastric Bypass: a Single-Centre Experience

Authors: Ioannis I. Lazaridis, Thomas Köstler, Lukas Kübler, Urs Zingg, Tarik Delko

Published in: Obesity Surgery | Issue 9/2022

Abstract

Purpose

Small bowel obstruction (SBO) due to internal hernias (IH) is a well-recognised complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Routine closure of the mesenteric defects (MDs) is recommended to reduce the risk of IH and subsequent SBO. However, data about the rates of reopening of the MDs after LRYGB is scarce. The main aim of this study was to evaluate the risk of reopening of the MDs after routine closure during LRYGB. The secondary objective was to determine any risk factors associated with the reopening of the MDs.

Methods

Data of all patients who underwent reoperations after LRYGB with closure of both MDs between January 2010 and December 2018 were retrospectively reviewed.

Results

A total of 162 patients were included. The median time between LRYGB and reoperation was 17 months. At the time of reoperation, both MDs were closed in 83 patients (51.2%); thus, 79 patients (48.8%) presented at least one open MD. The group of patients with preoperative diagnosis of SBO or with recurrent abdominal pain showed significantly higher rates of open Petersen’s space compared to the group of patients with other preoperative diagnoses. Preoperative body mass index (BMI) less than 40 kg/m² at time of LRYGB was associated with a higher risk for an open MD.

Conclusion

At least one MD reopened in almost half of the patients despite routine closure during LRYGB. Therefore, the status of MDs should be routinely examined during every reoperation after LRYGB and closure of open MDs should be performed.

Graphical abstract

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(3):782–95. https://doi.org/10.1007/s11695-018-3593-1.CrossRefPubMed

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. https://doi.org/10.1381/096089206778663689.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(12):1822–7. https://doi.org/10.1007/s11695-011-0462-6.CrossRefPubMed

Brolin RE, Kella VN. 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(6):850–4. https://doi.org/10.1016/J.SOARD.2012.11.007.CrossRefPubMed

Magouliotis DE, Tzovaras G, Tasiopoulou VS, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a meta-analysis. Obes Surg. 2020. https://doi.org/10.1007/s11695-020-04418-2.CrossRefPubMed

Delko T, Kraljević M, Köstler T, et al. Primary non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: reoperations and intraoperative findings in 146 patients. Surg Endosc. 2016;30(6):2367–73. https://doi.org/10.1007/s00464-015-4486-1.CrossRefPubMed

Kristensen SD, Floyd AK, Naver L, et al. Does the closure of mesenteric defects during laparoscopic gastric bypass surgery cause complications? Surg Obes Relat Dis. 2015;11(2):459–64. https://doi.org/10.1016/J.SOARD.2014.10.013.CrossRefPubMed

Nuytens F, D’Hondt M, Rooy F, et al. Closure of mesenteric defects is associated with a higher incidence of small bowel obstruction due to adhesions after laparoscopic antecolic Roux-en-y gastric bypass: a retrospective cohort study. Int J Surg. 2019;71:149–55. https://doi.org/10.1016/J.IJSU.2019.09.017.CrossRefPubMed

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

10.

Samur JS, Hurtado MB, Pérez-Castilla A, et al. Effect of the closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a prospective study. Surg Obes Relat Dis. 2019;15(11):1903–7. https://doi.org/10.1016/j.soard.2019.08.005.CrossRefPubMed

11.

Hope WW, Sing RF, Chen AY, et al. Failure of mesenteric defect closure after Roux-en-Y gastric bypass. J Soc Laparoendosc Surg. 2010;14(2):213–6. https://doi.org/10.4293/108680810X12785289144151.CrossRef

12.

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

13.

Stenberg E, Näslund I, Szabo E, et al. Impact of mesenteric defect closure technique on complications after gastric bypass. Langenbeck’s Arch Surg. 2018;403(4):481–6. https://doi.org/10.1007/s00423-018-1684-z.CrossRef

14.

Aghajani E, Nergaard BJ, Leifson BG. 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.

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

16.

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

17.

Angrisani L, Cutolo PP, Formisano G, et al. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis. 2013;9(3):405–13. https://doi.org/10.1016/j.soard.2012.11.011.CrossRefPubMed

18.

Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25. https://doi.org/10.1016/j.soard.2010.10.019.CrossRefPubMed

19.

Stenberg E, Ottosson J, Szabo E, et al. Comparing techniques for mesenteric defects closure in laparoscopic gastric bypass surgery—a register-based cohort study. Obes Surg. 2019;29(4):1229–35. https://doi.org/10.1007/s11695-018-03670-x.CrossRefPubMed

20.

Wang E, Shope T. Alternative method of mesenteric defect closure after Roux-en-Y gastric bypass. Obes Surg. 2019;29(2):751–3. https://doi.org/10.1007/s11695-018-03652-z.CrossRefPubMed

21.

Skidmore A, Aarts EO. Preventing Peterson’s space hernia using a BIO synthetic mesh. BMC Surg. 2021;21(1):1–6. https://doi.org/10.1186/s12893-021-01197-0.CrossRef

22.

Elango S, Perumalsamy S, Ramachandran K, et al. Mesh materials and hernia repair. Biomedicine. 2017;7(3):16. https://doi.org/10.1051/bmdcn/2017070316.CrossRefPubMedPubMedCentral

23.

Baylón K, Rodríguez-Camarillo P, Elías-Zúñiga A, et al. Past, present and future of surgical meshes a review. Membranes Basel. 2017;7:3. https://doi.org/10.3390/membranes7030047.CrossRef

24.

Schneider C, Cobb W, Scott J, et al. Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc. 2011;25(5):1594–8. https://doi.org/10.1007/s00464-010-1444-9.CrossRefPubMed

25.

Gandhi AD, Patel RA, Brolin RE. Elective laparoscopy for herald symptoms of mesenteric/internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(2):144–9. https://doi.org/10.1016/j.soard.2008.11.002.CrossRefPubMed

26.

Ahmed AR, Rickards G, Husain S, et al. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(12):1563–6. https://doi.org/10.1007/s11695-007-9260-6.CrossRefPubMed

Title: Risk of Reopening of the Mesenteric Defects After Routine Closure in Laparoscopic Roux-en-Y Gastric Bypass: a Single-Centre Experience
Authors: Ioannis I. Lazaridis
Thomas Köstler
Lukas Kübler
Urs Zingg
Tarik Delko
Publication date: 27-06-2022
Publisher: Springer US
Keyword: Recurrent Abdominal Pain
Published in: Obesity Surgery / Issue 9/2022
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-022-06179-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk of Reopening of the Mesenteric Defects After Routine Closure in Laparoscopic Roux-en-Y Gastric Bypass: a Single-Centre Experience

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 9/2022

Early Postoperative Weight Loss Predicts Weight Loss up to 5 Years After Roux-En-Y Gastric Bypass, Banded Roux-En-Y Gastric Bypass, and Sleeve Gastrectomy

Ten Years of Change in Bariatric/Metabolic Surgery in the Asia–Pacific Region with COVID-19 Pandemic: IFSO-APC National Reports 2021

The Impact of Bariatric Surgery on Nocturia Symptoms: a Systematic Review and Meta-Analysis

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

Reply to “Radiomics May Be a New Opportunity for Bariatric Surgery”

Fast-Track Laparoscopic Bariatric Surgery: Interest in Home Infusion and Intravenous Therapy