title: Does closure of the mesenteric defects during antecolic laparoscopic gastric bypass for morbid obesity reduce the incidence of symptomatic internal herniation?
abstract: A best evidence topic in surgery was written according to a structured protocol. The question asked was whether the closure of the mesenteric defects during laparoscopic gastric bypass via antecolic approach for morbid obesity reduces the incidence of symptomatic internal herniation. 251 papers were found using the reported search strategy of which three papers best represented the answer to the question. All three studies showed that by closuring the mesenteric defects, resulted in a reduction in the incidence of symptomatic internal hernias. One study showed there to be new complications arising from primary closure, but this was undetermined statistically. The evidence still however remains limited regarding the need for closure of mesenteric defects in gastric bypass operations. We recommend there is a need for large scale randomized control trials with suitable follow up for patients.
authors: Upper Gastrointestinal Surgery Department, St George's Healthcare NHS Trust, London, United Kingdom. nimsan@doctors.net.uk
authors: Nimalan
authors: N
authors: Sanmugalingam
authors: S
authors: S
authors: Nizar
authors: G
authors: G
authors: Vasilikostas
authors: M
authors: M
authors: Reddy
authors: A
authors: A
authors: Wan
mesh_terms: D058107:Abdominal Wound Closure Techniques; D015390:Gastric Bypass / Q000379:methods*; D046449:Hernia, Abdominal / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008643:Mesentery / Q000601:surgery*; D009767:Obesity, Morbid / Q000601:surgery*