• Surg Obes Relat Dis · Nov 2019

    Effect of the closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a prospective study.

    • Jorge Saba Samur, Magdalena Bravo Hurtado, Alberto Pérez-Castilla, Eugenio Rivas Zapata, Roberto Fernández Rodriguez, and Jorge Zajjur Castro.
    • Service of Bariatric and Metabolic Surgery, Indisa Clinic, Santiago, Chile; Surgery Service, Dipreca Hospital, Santiago, Chile. Electronic address: doctor@jorgesaba.cl.
    • Surg Obes Relat Dis. 2019 Nov 1; 15 (11): 1903-1907.

    BackgroundInternal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) to prevent IH in the LRYGB remains controversial.ObjectivesThe main objective of our study was to evaluate the risk of reopening at the level of both MDs, the Petersen space, and the intermesenteric gap.SettingUniversity hospital.MethodsProspective cohort of patients with a history of LRYGB, all with closure of both MDs, and in whom another intra-abdominal surgery was performed after the LRYGB, between January 2013 and December 2018. The status of both MDs was recorded. All analyses were performed with Stata version 15 software with a level of significance of .05.ResultsA total of 76 patients were included. The average time that elapsed between the LRYGB and the surgery that evaluated the state of the MDs was 22.8 months. The patients lost on average 34.7 kg, with a minimum of 8 kg and a maximum of 76 kg. The indications for the interventions were cholelithiasis (68.3%), recurrent abdominal pain (13.2%), intestinal obstruction (11.8%), malabsorption syndrome (7.3%), and bilateral inguinal hernia (2.4%). At the time of surgery, 52 patients (68.4%) had a completely closed Petersen space; 58 patients (76.3%) had a completely closed intermesenteric defect. Both MDs were closed in 36 patients (47.4%), and 33 patients (43.4%) had at least 1 of the MDs open.ConclusionThe closure of MDs eliminated the risk of IH in half of the operated patients of LRYGB in this series.Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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