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Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial

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Abstract

Introduction

Internal herniation is a potential complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Previous studies have shown that closure of mesenteric defects after LRYGB may reduce the incidence of internal herniation. However, controversy remains as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after LRYGB. This study aims to determine if jejeunal mesenteric defect closure reduces incidence of internal hernias and other complications in patients undergoing LRYGB.

Methods

105 patients undergoing laparoscopic antecolic RYGB were randomized into two groups: closed mesenteric defect (n = 50) or open mesenteric defect (n = 55). Complication rates were obtained from the medical record. Patients were followed up to 3 years post-operatively. Patients also completed the gastrointestinal quality of life index (GI QoL) pre-operatively and 12 months post-operatively. Outcome measures included: incidence of internal hernias, complications, readmissions, reoperations, GI QoL scores, and percent excess weight loss (%EWL).

Results

Pre-operatively, there were no significant differences between the two groups. The closed group had a longer operative time (closed-153 min, open-138 min, p = 0.073). There was one internal hernia in the open group. There was no significant difference at 12 months for decrease in BMI (closed-15.9, open-16.3 kg/m2, p = 0.288) or %EWL (closed-75.3 %, open-69.0 %, p = 0.134). There was no significant difference between the groups in incidence of internal hernias and general complications post-operatively. Both groups showed significantly improved GI QoL index scores from baseline to 12 months post-surgery, but there were no significant differences at 12 months between groups in total GI QoL (closed-108, open-112, p = 0.440).

Conclusions

In this study, closure or non-closure of the jejeunal mesenteric defect following LRYGB appears to result in equivalent internal hernia and complication rates. High index of suspicion should be maintained whenever internal hernia is expected after LRYGB.

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Acknowledgments

We would like to thank the multi-disciplinary team of medical students, physicians, nurses, and dieticians at the Stanford Bariatric and Metabolic Interdisciplinary clinic for their support throughout this clinical investigation.

Disclosures

Dr. John Morton is a consultant for Ethicon and Covidien. Dr. Homero Rivas is a consultant for Ethicon. Ulysses Rosas, Natalia Leva, Trit Garg, and Drs. Shusmita Ahmed, Michael Russo, and James Lau have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA

    Ulysses Rosas, Shusmita Ahmed, Natalia Leva, Trit Garg, Homero Rivas, James Lau, Michael Russo & John M. Morton

  2. Division of Bariatric and Minimally Invasive Surgery at Stanford Hospital and Clinics, Stanford, USA

    Homero Rivas, James Lau, Michael Russo & John M. Morton

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  1. Ulysses Rosas
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  2. Shusmita Ahmed
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  3. Natalia Leva
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  4. Trit Garg
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  6. James Lau
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  7. Michael Russo
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  8. John M. Morton
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Correspondence to John M. Morton.

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Rosas, U., Ahmed, S., Leva, N. et al. Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. Surg Endosc 29, 2486–2490 (2015). https://doi.org/10.1007/s00464-014-3970-3

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  • DOI: https://doi.org/10.1007/s00464-014-3970-3

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