title: Mesenteric irritation as a means to prevent internal hernia formation after laparoscopic gastric bypass surgery.
abstract: BACKGROUND
  Internal hernias (IHs) occur more frequently in laparoscopic gastric bypass (LGB) surgery than in the classic open procedure. The incidence of small bowel obstruction after LGB ranges from 1.8% and 9.7%. Some have theorized that this occurs because of decreased adhesion formation.
  
  
  METHODS
  The mesenteric irritation technique is performed after closure of the jejunojejunal mesenteric defect with a running 2-0 silk suture. A sponge is then rubbed against the closed visceral peritoneal mesentery until petechiae are visualized on the surface of the mesentery.
  
  
  RESULTS
  In all, 338 LGBs were performed using the standard closure technique with an IH incidence of 5.3% (range 1.7% to 7.8%). When using the mesenteric irritation technique, 72 LGBs were performed with an IH rate of 1.4% (P = .13).
  
  
  CONCLUSIONS
  Mesenteric irritation is a novel technique performed with minimal additional time and no additional equipment. This technique may prove beneficial in reducing the incidence of IHs.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA. Electronic address: avery.walker@us.army.mil.
authors.forename: Avery S
authors.initials: AS
authors.lastname: Walker
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Bingham
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA.
authors.forename: Marlin W
authors.initials: MW
authors.lastname: Causey
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Sebesta
mesh_terms: D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Internal hernia; Laparoscopic gastric bypass; Mesenteric defect; Small bowel obstruction