Authors: Ulysses Rosas Shusmita Ahmed Natalia Leva Trit Garg Homero Rivas James Lau Michael Russo John M Morton
Publish Date: 2014/12/06
Volume: 29, Issue: 9, Pages: 2486-2490
Abstract
Internal herniation is a potential complication following laparoscopic RouxenY 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 LRYGB105 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 postoperatively Patients also completed the gastrointestinal quality of life index GI QoL preoperatively and 12 months postoperatively Outcome measures included incidence of internal hernias complications readmissions reoperations GI QoL scores and percent excess weight loss EWLPreoperatively there were no significant differences between the two groups The closed group had a longer operative time closed153 min open138 min p = 0073 There was one internal hernia in the open group There was no significant difference at 12 months for decrease in BMI closed159 open163 kg/m2 p = 0288 or EWL closed753 open690 p = 0134 There was no significant difference between the groups in incidence of internal hernias and general complications postoperatively Both groups showed significantly improved GI QoL index scores from baseline to 12 months postsurgery but there were no significant differences at 12 months between groups in total GI QoL closed108 open112 p = 0440In this study closure or nonclosure 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 LRYGBDr 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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