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Establishing Methods of Defect Closure in Roux-en-Y Gastric Bypass: an International Survey

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Abstract

Introduction

Internal herniation (IH) can be a life-threatening complication of Roux-en-Y gastric bypass (RYGB). Randomised controlled trials support the routine closure of mesenteric spaces at RYGB. However, there is currently no consensus on the method of closure in clinical practice. The purpose of this survey is to understand bariatric surgeons’ practice in this regard.

Methods

We conducted an international survey, whereby questions were created through collaboration of a consensus group of bariatric surgeons and hosted on the SurveyMonkey platform. The survey was distributed among British Obesity and Metabolic Surgery Society (BOMSS) members and international professional channels including The Upper Gastrointestinal Society (TUGS) and social media.

Results

One hundred and thirty-six surgeons from 34 countries completed the survey. Of these, 49 respondents were UK-based surgeons with a cumulative experience of approximately 2500 RYGB per annum. Forty-five (91.8%) respondents reported always closing mesenteric defects, of whom 57.8% elected to use non-absorbable non-barbed sutures, followed by staples/clips in 28.9% and a selection of other methods. Most respondents used more than one method. A total of 2 UK and 14 non-UK participants reported never closing mesenteric spaces.

Conclusions

This survey has shown heterogeneity among defect closure and no consensus on preferred type. Additionally, there remains a practice of non-closure of mesenteric defects. We hope these findings help to inform further needed research and consensus building among experts.

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Authors and Affiliations

  1. South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

    Ghazaleh Mohammadi-Zaniani, Sharmaine Yen Ling Quake, Aya Musbahi, Neil Andrew Jennings, Michael John Courtney & Peter Kenneth Small

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  1. Ghazaleh Mohammadi-Zaniani
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  2. Sharmaine Yen Ling Quake
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  3. Aya Musbahi
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Corresponding author

Correspondence to Ghazaleh Mohammadi-Zaniani.

Ethics declarations

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Dr. Ghazaleh Mohammadi-Zaniani: No conflict of interest to declare

Dr. Sharmaine Quake: No conflict of interest to declare

Dr. Aya Musbahi: No conflict of interest to declare

Dr. Neil Jennings: No conflict of interest to declare

Dr. Michael Courtney: No conflict of interest to declare

Dr. Peter Small: Dr. Small is a past chairman and current member of the trustee board of BOMSS. Both roles are in an unpaid capacity.

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Key points

• Most bariatric surgeons worldwide report regular mesenteric defect closure.

• No trend in closure method choice was observed through this survey.

• A few surgeons continue to practice regular non-closure of defects.

• Further research comparing closure methods is required.

Appendix

Appendix

Survey transcript

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Mohammadi-Zaniani, G., Quake, S.Y.L., Musbahi, A. et al. Establishing Methods of Defect Closure in Roux-en-Y Gastric Bypass: an International Survey. OBES SURG 33, 1049–1059 (2023). https://doi.org/10.1007/s11695-022-06420-2

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  • DOI: https://doi.org/10.1007/s11695-022-06420-2

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