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Primary non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: reoperations and intraoperative findings in 146 patients

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Abstract

Background

Internal hernias (IH) after laparoscopic Roux-en-Y gastric bypass (LRYGB) have been reported with an incidence of 11 %. IH can lead to bowel incarceration and potentially bowel necrosis. The aim of this study was to analyze reoperations and intraoperative findings in a cohort of patients with unclosed mesenteric defects.

Methods

From a prospective database of patients with LRYGB, we selected as primary cohort patients with non-closure of mesenteric defects and abdominal reoperation for analysis. The data included pre-, intra- and post-operative findings, computed tomogram results and laboratory test results. This group underwent a very very long limb LRYGB, at that time the institutional standard technique. Additionally, a more recently operated cohort with primary closure of mesenteric defects was also analyzed.

Results

We identified 146 patients with primary non-closure and reoperation, mean age of 43.8 years. The main indication for reoperation was unclear abdominal pain in 119 patients with 27 patients undergoing a reoperation for other reasons (weight regain, prophylactic surgical inspection of mesenteric defects). Median time and mean excess weight loss from RYGB to reoperation were 41.1 months and 62.7 %, respectively. The incidence of IH was 14.4 %, with all patients with an IH being symptomatic. Conversion rate from laparoscopic to open surgery was 5.5 %, mortality 0.7 % and morbidity 3.4 %. Thirty-one patients underwent a second re-look laparoscopy. Eleven patients had recurrent open mesenteric defects. Three hundred and sixteen patients who underwent primary closure of the mesenteric defects had a reoperation rate of 13.6 % and an IH rate of 0.6 %.

Conclusion

The incidence of IH in patients without closure of mesenteric defects and reoperation is high and substantially higher compared to patients with primary closure of mesenteric defects. Patients with or without closure of mesenteric defects following LRYGB with acute, chronic or recurrent pain should be referred to a bariatric surgeon for diagnostic laparoscopy.

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    Authors and Affiliations

    1. Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

      Tarik Delko, Marko Kraljević, Raoul Droeser & Daniel Oertli

    2. Department of General Surgery, Limmattal Hospital, 8952, Schlieren, Switzerland

      Thomas Köstler, Silke Potthast & Urs Zingg

    3. Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, 5042, Australia

      Lincoln Rothwell

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    1. Tarik Delko
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    2. Marko Kraljević
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    Correspondence to Tarik Delko.

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    Dr. Delko, Dr. Kraljević, Dr. Köstler, Dr. Rothwell, Dr. Droeser, Dr. Potthast, Dr. Oertli and Dr. Zingg have nothing to disclose.

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    Tarik Delko and Marko Kraljević have contributed equally to this work.

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    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 30, 2367–2373 (2016). https://doi.org/10.1007/s00464-015-4486-1

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