title: Impact of complete mesenteric closure on small bowel obstruction and internal mesenteric hernia after laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Although it is generally accepted that closure of mesenteric defects after laparoscopic Roux-en-Y gastric bypass (LRYGB) reduces the incidence of small bowel obstruction (SBO), data supporting this belief are inconsistent. After a spike in acute SBO cases in our LRYGB patients, we changed our technique of mesenteric closure. The objective of this study was to determine whether modification of our technique of mesenteric closure would decrease the incidence of SBO and internal hernia after LRYGB.
  
  
  METHODS
  The records of 872 consecutive patients who had antecolic LRYGB by 1 surgeon over a 9-year interval were reviewed for acute SBO. The first 654 patients, mean follow up = 100±12 months, had incomplete mesenteric closure versus complete closure in 218 remaining patients, mean follow up = 40±14 months. Minimum follow up was 1 year.
  
  
  RESULTS
  Total incidence of acute SBO was 4.0% (35/872), including 4.4% (29/654) in the incomplete closure group versus 2.8% (6/218) in the complete closure patients. Seventeen (2.6%) of the incomplete closure patients with acute SBO had internal hernias versus 1 (.5%) in the complete closure group. Twenty-six patients with incomplete closure developed symptoms of SBO and subsequently had elective repair of mesenteric hernias versus none in complete closure group (P<.02). Postoperative morbidity and mortality rates after surgery for SBO were 30% and 7.4% in incomplete group versus zero in patients with complete closure.
  
  
  CONCLUSIONS
  Complete closure of mesenteric defects in antecolic LRYGB resulted in a significant reduction in internal mesenteric hernias. Complications were also reduced after operations for SBO in patients who had complete mesenteric closure.
authors: University Medical Center at Princeton, Plainsboro, New Jersey. Electronic address: rbrolin@njbariatricspc.com.
authors: Robert E
authors: RE
authors: Brolin
authors: Venkata N
authors: VN
authors: Kella
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Bariatric surgery; Gastric bypass; Laparoscopic surgery; Mesenteric hernia; Small bowel obstruction