title: Non-closure of defects during laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The concern about internal hernias has prompted recommendations for routine closure of defects during laparoscopic Roux-en-Y gastric bypass (LRYGBP). Our belief is that not all techniques require closure of defects. We hypothesize that non-closure of defects with our particular technique would not cause a significant clinically evident internal hernia rate.
  
  
  METHODS
  All patients who were operated on between December 2002 and June 2005 were included in this study. The technique that was utilized included an antecolic antegastric gastrojejunostomy (GJ), division of the greater omentum, a long jejunojejunostomy (JJ) performed with three staple-lines, a short (< 4 cm) division of the small bowel mesentery, and placement of the JJ above the colon in the left upper quadrant. Clinical records were reviewed for reoperations.
  
  
  RESULTS
  There was a total of 300 patients, and no incidence of internal hernia. In the first 100 patients, there was 97% follow-up for 1 year or more. Four patients underwent reoperations for unexplained abdominal pain. Intraoperative findings included an adhesive band from the JJ to the colon (1), an adhesive band from the JJ to the anterior abdominal wall (1), an adhesive band 3 cm from the GJ to the anterior abdominal wall (1), and adhesions of the jejunum to the anterior abdominal wall (1). No patient had an internal hernia.
  
  
  CONCLUSIONS
  Internal hernias are not common after this particular method of LRYGBP. Before adopting routine closure of potential spaces, surgeons should consider their technique, follow-up, and incidence of internal hernias. Routine closure of these defects is not always necessary.
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, University of Tennessee Health Science Center Memphis, TN 38163, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Finnell
authors.forename: Atul K
authors.initials: AK
authors.lastname: Madan
authors.forename: David S
authors.initials: DS
authors.lastname: Tichansky
authors.forename: Craig
authors.initials: C
authors.lastname: Ternovits
authors.forename: Raymond
authors.initials: R
authors.lastname: Taddeucci
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D046449:Hernia, Abdominal / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome