title: Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial.
abstract: BACKGROUND
  Internal herniation is a potential complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Previous studies have shown that closure of mesenteric defects after LRYGB may reduce the incidence of internal herniation. However, controversy remains as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after LRYGB. This study aims to determine if jejeunal mesenteric defect closure reduces incidence of internal hernias and other complications in patients undergoing LRYGB.
  
  
  METHODS
  105 patients undergoing laparoscopic antecolic RYGB were randomized into two groups: closed mesenteric defect (n = 50) or open mesenteric defect (n = 55). Complication rates were obtained from the medical record. Patients were followed up to 3 years post-operatively. Patients also completed the gastrointestinal quality of life index (GI QoL) pre-operatively and 12 months post-operatively. Outcome measures included: incidence of internal hernias, complications, readmissions, reoperations, GI QoL scores, and percent excess weight loss (%EWL).
  
  
  RESULTS
  Pre-operatively, there were no significant differences between the two groups. The closed group had a longer operative time (closed-153 min, open-138 min, p = 0.073). There was one internal hernia in the open group. There was no significant difference at 12 months for decrease in BMI (closed-15.9, open-16.3 kg/m(2), p = 0.288) or %EWL (closed-75.3%, open-69.0%, p = 0.134). There was no significant difference between the groups in incidence of internal hernias and general complications post-operatively. Both groups showed significantly improved GI QoL index scores from baseline to 12 months post-surgery, but there were no significant differences at 12 months between groups in total GI QoL (closed-108, open-112, p = 0.440).
  
  
  CONCLUSIONS
  In this study, closure or non-closure of the jejeunal mesenteric defect following LRYGB appears to result in equivalent internal hernia and complication rates. High index of suspicion should be maintained whenever internal hernia is expected after LRYGB.
authors.affiliation: Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Rosas
authors.forename: Shusmita
authors.initials: S
authors.lastname: Ahmed
authors.forename: Natalia
authors.initials: N
authors.lastname: Leva
authors.forename: Trit
authors.initials: T
authors.lastname: Garg
authors.forename: Homero
authors.initials: H
authors.lastname: Rivas
authors.forename: James
authors.initials: J
authors.lastname: Lau
authors.forename: Michael
authors.initials: M
authors.lastname: Russo
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D046449:Hernia, Abdominal / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011184:Postoperative Period; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies