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Anatomical Basis for the Low Incidence of Internal Hernia After a Laparoscopic Roux-en-Y Gastric Bypass Without Mesenteric Closure

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Abstract

Background

Different techniques have been designed to reduce the rate of internal hernia (IH) after laparoscopic bariatric surgery, and mesenteric closure is possibly the most controversial. We propose a laparoscopic Roux-en-Y gastric bypass (LRYGB) procedure without mesenteric closure with several specific technical details to avoid IH. To support this view, we have reviewed the outcome of our LRYGB patients and have carried out an anatomical study on cadavers.

Methods

A retrospective observational study was carried out using the Unit’s prospective database. The patients selected were those who were operated on for morbid obesity using LRYGB and who presented to the Emergency Unit with symptoms of intestinal obstruction (IO). Data concerning demographics, weight progress, technical details of the surgery, follow-up percentage, morbidity, and mortality were collected. Furthermore, an anatomical model was made in order to recreate the surgery on cadavers.

Results

Only 1.6 % of postoperative IO and very few (0.3 %) of IH cases were associated with our technique of LRYGB without mesenteric closure. The anatomical model showed two large potential hernia spaces, but their supramesocolic situation, the orientation of the bowel loops, leaving the mesentery and omentum undivided and the antecolic passage of the alimentary limb made intestinal herniation difficult even though the mesenteric spaces were not closed.

Conclusions

With a proper technique, the closure of mesenteric spaces after a LRYGB is not essential to avoid postoperative IH in bariatric patients, as evidenced in an anatomical model.

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Conflict of Interest

All authors declare no conflict of interest.

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Authors and Affiliations

  1. Unit of Endocrine and Bariatric Surgery, Hospital Clinico Universitario, Avda. Blasco Ibanez, 17, 46010, Valencia, Spain

    Joaquin Ortega, Norberto Cassinello, David Sánchez-Antúnez & Consuelo Sebastián

  2. Department of Surgery, University of Valencia, Avda. Blasco Ibanez, 17, 46010, Valencia, Spain

    Joaquin Ortega

  3. Department of Anatomy and Human Embriology, University of Valencia, Avda. Blasco Ibanez, 17, 46010, Valencia, Spain

    Francisco Martínez-Soriano

Authors
  1. Joaquin Ortega
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  2. Norberto Cassinello
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  3. David Sánchez-Antúnez
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  4. Consuelo Sebastián
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  5. Francisco Martínez-Soriano
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Correspondence to Joaquin Ortega.

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Ortega, J., Cassinello, N., Sánchez-Antúnez, D. et al. Anatomical Basis for the Low Incidence of Internal Hernia After a Laparoscopic Roux-en-Y Gastric Bypass Without Mesenteric Closure. OBES SURG 23, 1273–1280 (2013). https://doi.org/10.1007/s11695-013-0902-6

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  • DOI: https://doi.org/10.1007/s11695-013-0902-6

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