Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass.
BACKGROUND
Although most surgeons believe that internal hernia (IH) defects should be closed, no general consensus has yet been reached. The published studies have reported conflicting obstruction incidence estimates and variations in location. Some have also argued that closed hernia sites recur.


METHODS
A retrospective review of 2079 Roux-en-Y gastric bypass procedures performed by 1 surgeon from 2001 to 2009 was conducted. Chi-square analysis compared those performed from 2001 to August 2003 (group 1) with those from September 2003 to 2009 (group 2) for the incidence of IH. Since September 2003, the jejunojejunal anastomotic mesenteric defect has been closed with a running, permanent suture. In contrast, before September 2003, the defect was not closed.


RESULTS
A total of 37 patients presented with symptomatic IH from 2001 to 2009. A significant difference was found in the proportion of those patients who experienced IH in group 1 (n = 36) compared with those who did so in group 2 (n = 1; P <.001). Group 1 developed 35 IHs (10%) at the jejunojejunal anastomotic mesenteric defect and 6 (1.7%) at Petersen's defect. The median interval to presentation was 20 months (range 5-34). Of the 35 patients, 5 (1.4%) presented acutely with pain or bowel obstruction. Group 2 developed no IHs at the mesenteric defect (0%) and 1 at Petersen's defect (.1%). The interval to presentation was 9 months.


CONCLUSIONS
The incidence of IH after laparoscopic Roux-en-Y gastric bypass can be reduced with closure of mesenteric defects. IHs can present either acutely with pain and obstructive symptoms or chronically with vague, intermittent postprandial pain.
Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. ndelacruz@med.miami.edu
Nestor
N
de la Cruz-Muñoz
Juan C
JC
Cabrera
Melissa
M
Cuesta
Scott
S
Hartnett
Renan
R
Rojas
D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008643:Mesentery / Q000601:surgery*; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors