• Frederiek Nuytens, Mathieu D'Hondt, Frank Van Rooy, Franky Vansteenkiste, Hans Pottel, Mohammed Abasbassi, Ann Servaege, and Dirk Devriendt.
• Department of Digestive and Hepatobiliary/pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium. Electronic address: frederiek.nuytens@gmail.com.
• Int J Surg. 2019 Nov 1; 71: 149-155.

IntroductionSmall bowel obstruction (SBO) is a frequent complication after laparoscopic Roux-en-y gastric bypass (LRYGB).ObjectivesWe wanted to evaluate the effect of closure of the mesenteric defects on the incidence of SBO and postoperative complications after LRYGB. Furthermore, we wanted to identify possible risk factors for SBO.MethodsThis study was a retrospective cohort study of 1364 patients who underwent a LRYGB between July 2003 and October 2015. Cohort 1 contained 724 patients in whom mesenteric defects were not closed. Cohort 2 contained 640 patients in whom mesenteric defects were closed. Main outcome parameters were the incidence of SBO and postoperative complications as well as potential risk factors for SBO.ResultsClosure of the mesenteric defects was associated with a reduction in the incidence of SBO due to internal herniation (4.8% vs. 5.5, p = 0.02) but resulted in a higher incidence of SBO due to postoperative adhesions (4.8% vs. 1.7%, p = 0.004). Multivariate analysis identified smoking as a risk factor for SBO (p = 0.0187). We observed a higher incidence of late postoperative pain in cohort 2 (5.3% vs. 2.1%, p = 0.007).ConclusionAlthough closure of the mesenteric defects is associated with a lower incidence of SBO due to internal herniation, this effect is countered by a higher incidence of SBO due to postoperative adhesions. Smoking is an independent risk factor for SBO after LRYGB. Closure of the mesenteric defects is associated with a higher incidence of late postoperative pain.Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

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