title: Does the closure of mesenteric defects during laparoscopic gastric bypass surgery cause complications?
abstract: BACKGROUND
  A well-known complication of laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) is bowel obstruction due to internal herniation (IH). Evidence suggests that mesenteric defects should be closed during LRYGB to reduce the risk of IH. Therefore, surgeons are now closing mesenteric defects during LRYGB using sutures, clips, or fibrin glue. However, it has been reported that complications may arise due to the closure of mesenteric defects. The aim of this review was to summarize the reported possible complications associated with the closure of mesenteric defects during LRYGB.
  
  
  METHODS
  A literature search of PubMed and EMBASE was performed to identify studies related to the closure of mesenteric defects during LRYGB. The studies were screened for the listing of possible complications associated with the closure of mesenteric defects. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations.
  
  
  RESULTS
  Thirty studies complied with the inclusion criteria for our analysis, which included 21,789 patients. Reported complications related to closure of the mesenteric defects were: small bowel obstruction because of IH, kinking, and adhesions. IH occurred because of incomplete closure of the mesenteric defects in 1.4% of all patients, 1.2% by the antecolic approach, and 1.9% by the retrocolic approach, respectively. Kinking of the small bowel occurred in .2% of 1630 patients after closure of the mesenteric defects with clips and adhesion formation was found among 4.6% of 152 patients after closure of the mesenteric defects with nonabsorbable sutures.
  
  
  CONCLUSIONS
  The reported risk of complications caused by closure of the mesenteric defects during LRYGB seems low.
authors: Department of Surgery, Koege Hospital, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark. Electronic address: sark@regionsjaelland.dk.
authors: Sara Danshøj
authors: SD
authors: Kristensen
authors: Department of Surgery, Koege Hospital, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark.
authors: Andrea Karen
authors: AK
authors: Floyd
authors: Department of Surgery, Koege Hospital, Denmark.
authors: Lars
authors: L
authors: Naver
authors: Department of Surgery, Roskilde Hospital, Denmark.
authors: Per
authors: P
authors: Jess
mesh_terms: D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006547:Hernia / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D008643:Mesentery / Q000601:surgery*
keywords: Clips; Closure of the mesenteric defects; Complications; Fibrin glue; Hematoma; Internal herniation; Kinking of the small bowel; Laparoscopic Roux-en-Y gastric bypass; Mesenteric defects; Small bowel obstruction; Sutures