Mesenteric Defect Closure and Prevention of Internal Herniation Following Laparoscopic Roux-en-Y Gastric Bypass

Background: Internal herniation is a dangerous complication following laparoscopic roux-en-y gastric bypass (LRYGB). Available studies have shown no clear benefit to operative closure of the jejunal mesenteric defect at the time of LRYGB.
Objective: To analyze the impact of mesenteric defect closure on the incidence of internal herniation following LRYGB.
Methods: We performed a retrospective study of all patients undergoing LRYGB at our center between December 1999 and August 2007. Between December 1999 and January 2006 (Group A), patients underwent LRYGB without closure of the mesenteric defect. Subsequently, between February 2006 and August 2007 (Group B), patients underwent LRYGB with closure of the mesenteric defect. We compared the 2 groups with regard to rates of internal herniation. Data collected included demographics, operative time, interval between primary operation and reoperation for internal herniation, BMI, and % excess weight loss (%EWL) at the time of reoperation.
Results: 1194 patients included in Group A underwent LRYGB without mesenteric defect closure. Within this group, a total of 16 patients experienced internal herniation requiring reoperation (1.3%). Demographics for this subgroup were as follows: 13 female, 3 male; mean age 39.9 years (range 24-62); mean preoperative weight 295 lbs (range 210-448); mean preoperative BMI 48.8 kg/m2 (range 36-65). The mean interval between LRYGB and reoperation was 387 days (range 2-792). Mean weight, BMI, and %EWL at the time of reoperation were 201.5 lbs (range 114-315), 33 kg/m2 (range 20.2-48.7), and 59.0% (range 0-101.4), respectively. All 16 patients underwent laparoscopic reexploration, with reduction of the herniated small intestine and closure of the mesenteric defect. 2 patients (12.5%) required decompressive gastrostomy tube placement due to distension of the biliopancreatic limb. 469 patients included in Group B underwent LRYGB with mesenteric defect closure. Thus far, no patients (0%) in Group B have experienced internal herniation (p

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