Incidence of complications following colectomy with mesenteric closure versus no mesenteric closure: does it really matter?
BACKGROUND
There remains strong opinion but very little data to support the way that the resultant mesenteric defect is handled following colectomy. Despite case reports of internal hernias and subsequent bowel obstruction requiring operative intervention, no larger series have evaluated this question.


METHODS
Retrospective review of elective right and left/sigmoid colectomies during the period from 2004 to 2007. Patients were stratified by the method of handling the mesenteric defect (open versus closed), with the primary endpoint of complications potentially directly attributable to the closure or failure to close the mesenteric defect. Preoperative and intraoperative risk factors were also analyzed as covariables.


RESULTS
One hundred thirty-three patients (76 male; 57 female; mean age 59±15 years) with a median follow-up of 39.5 mo were identified. Thirty-six percent underwent a right hemicolectomy, 33% sigmoidectomy, 11% left hemicolectomy, 9% low anterior resection, and 5% ileocectomy. Overall, 24% of the surgeries were done laparoscopically and 52% had their mesenteric defect closed. The overall complication rate was 27.8% and eight patients (6%) developed a postoperative complication near the mesenteric defect (anastomotic leakage or small bowel obstruction). By multivariate analysis, mesenteric defect closure was the only significant factor identified with the development of complications near the mesenteric defect (OR=5.5; 95% CI 1.069-28.524, P=0.041). No other preoperative or intraoperative factors were found to have an impact on the complication rate.


CONCLUSIONS
Closure of the mesenteric defect was associated with a higher rate of complications, and demonstrated no benefit in abdominal colectomy.
Causey
Marlin W
MW
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington 98431, USA. mwcausey@msn.com
Oguntoye
Morohunranti
M
Steele
Scott R
SR
D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000453:epidemiology* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D003424:Crohn Disease / Q000453:epidemiology / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors