Obesity Surgery

, Volume 29, Issue 2, pp 751–753 | Cite as

Alternative Method of Mesenteric Defect Closure after Roux-en-Y Gastric Bypass

  • Eugene Wang
  • Timothy ShopeEmail author
Video Submission



Roux-en-Y gastric bypass is the gold standard for weight loss surgery. This procedure creates two to three mesenteric defects, depending on ante-colic versus retro-colic technique. Current literature supports mesenteric defect closure, but there is no consensus on how to best close these defects. Described options include running separate suture lines for each defect, or employing endoscopic staplers for defect closure.


This is a video/dynamic manuscript on operative technique.


We describe an alternative technique that does not require an extra laparoscopic instrument and is more efficient than traditional suture lines due to less suturing.


The technique maintains low gastric bypass complication rates by closing mesenteric defects, while keeping intra-operative costs low, and minimizing time spent on the defect closures.


Mesenteric defect Internal hernia Gastric bypass Closure Technique One suture 



Conception, design, overall responsibility: TS

Writing the article: EW, TS

Critical revision of the article: TS

Final approval of the article: TS

Compliance with Ethical Standards

Funding and Conflict of Interest Statement

The authors (Author 1, Author 2) declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Informed Consent and Human Rights Statement

Does not apply

Supplementary material


(MP4 280,474 kb)


  1. 1.
    English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(12):1637–9.Google Scholar
  2. 2.
    Acquafresca PA, Palermo M, Rogula T, et al. Early surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig. 2015;28(1):74–80.CrossRefGoogle Scholar
  3. 3.
    Palmero M, Acquafresca PA, Rogula T, et al. Late surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig. 2015;28(2):139–43.CrossRefGoogle Scholar
  4. 4.
    Steele KE, Prokopowicz GP, Magnuson T, et al. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc. 2008;22(9):2056–61.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Geubbels N, Lijftogt N, Fiocco M, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102(5):451–60.CrossRefGoogle Scholar
  7. 7.
    Stenberg E, Szabo E, Ottosson J, et al. Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database. Br J Surg. 2017;104(5):562–9.CrossRefGoogle Scholar
  8. 8.
    Kojima K, Inokuchi M, Kato K, et al. Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer. Gastric Cancer. 2014;17(1):146–51.CrossRefGoogle Scholar
  9. 9.
    Leyba JL, Navarrete S, Navarrete Llopis S, et al. Laparoscopic technique for hernia reduction and mesenteric defect closure in patients with internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass. Surg Laparosc Endosc Percutan Tech. 2012;22(4):182–5.CrossRefGoogle Scholar
  10. 10.
    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(3):641–5.CrossRefGoogle Scholar
  11. 11.
    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.CrossRefGoogle Scholar
  12. 12.
    Kristensen SD, Naver L, Jess P, et al. Effect of closure of the mesenteric defect during laparoscopic gastric bypass and prevention of internal hernia. Dan Med J. 2014;61(6):A4854.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, Section of Advanced Laparoscopic and Bariatric SurgeryMedStar Washington Hospital CenterWashingtonUSA

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