title: Antecolic or Retrocolic Alimentary Limb in Laparoscopic Roux-en-Y Gastric Bypass? A Meta-Analysis.
abstract: Internal hernia (IH) is a severe complication after laparoscopic Roux-en-Y gastric bypass. The orientation of the alimentary limb has advocated to affect IH. Available data regarding the incidence of IH, gastro-jejunostomy leakage, obstructive symptoms, anastomotic obstruction, adhesion, incisional hernia, total complications, and recurrent IH were meta-analyzed according to the orientation of the alimentary limb. Fourteen studies (13,660 patients) were included. Antecolic orientation resulted associated with a lower incidence of IH and obstructive symptoms, while the route of the alimentary limb did not show to affect the other outcomes. Antecolic orientation decreases the IH. However, the role and the technique of the closure of mesenteric defects cannot be stated due to the lack of adequate data to date. Well-designed randomized controlled trials (RCTs) are needed.
authors.affiliation: General Surgery, "Bellinzona e Valli" Regional Hospital, 6500, Bellinzona, Switzerland.|Department of Surgical and Biomedical Sciences, University of Perugia, Via G. Dottori, 06100, Perugia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.affiliation: General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Italy. walterbugiantella@alice.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: General Surgery, "Bellinzona e Valli" Regional Hospital, 6500, Bellinzona, Switzerland.
authors.forename: Matteo
authors.initials: M
authors.lastname: Desio
authors.affiliation: Department of Medicine, Internal and Cardiovascular Medicine and Stroke Unit, "Santa Maria della Misericordia" Hospital, University of Perugia, Via G. Dottori, 06100, Perugia, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Boni
authors.affiliation: General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: General Surgery, "Bellinzona e Valli" Regional Hospital, 6500, Bellinzona, Switzerland.
authors.forename: Adriano
authors.initials: A
authors.lastname: Guerra
mesh_terms: D015390:Gastric Bypass / Q000379:methods*; D046449:Hernia, Abdominal / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy
keywords: Antecolic; Gastric bypass; Internal hernia; Laparoscopy; Meta-analysis; Occlusion; Retrocolic