title: The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique.
abstract: Internal hernia (IH) is a common complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Little large-volume data exist on how to handle the mesenteric defects during LRYGB. This study evaluated long-term follow-up (5.5 years) of 2443 patients with primary closure of the mesenteric defects with a stapling device at LRYGB, in comparison with a non-closed group from the same centre.
  
  
  
  All patients (N = 4013) undergoing LRYGB over a 10-year period (2005-2015) at a single institution were evaluated. The mesenteric defects were routinely closed starting June 2010. In total, 1570 non-closure patients and 2443 patients with stapled closure of the defects were prospectively entered and the results analysed.
  
  
  
  Closure of the mesenteric defects increased surgical time by 4 min and did not affect the 30-day complication rate. IH incidence was significantly lower (2.5%) in the closure group compared with 11.7% in the non-closure group, at 60 months. The relative risk reduction by closing the mesenteric defects was 4.09-fold (95% CI = 2.97-5.62) as calculated using a survival model.
  
  
  
  Internal hernia after LRYGB occurs frequently if mesenteric defects are left unclosed. Primary closure with a hernia-stapling device is safe and significantly reduces the risk of internal hernia.
authors.affiliation: Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway. Ebrahim.Aghajani@Aleris.no.
authors.forename: Ebrahim
authors.identifier: 0000-0002-4383-9581
authors.initials: E
authors.lastname: Aghajani
authors.affiliation: Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway.
authors.forename: Bent J
authors.initials: BJ
authors.lastname: Nergaard
authors.affiliation: Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway.
authors.forename: Bjorn G
authors.initials: BG
authors.lastname: Leifson
authors.affiliation: Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Hedenbro
authors.affiliation: Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway.
authors.forename: Hjortur
authors.initials: H
authors.lastname: Gislason
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D046449:Hernia, Abdominal / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control*; D040242:Risk Reduction Behavior; D017792:Surgical Stapling; D055815:Young Adult
keywords: Bariatric surgery; Complication; Internal hernia; Laparoscopic Roux-en-Y gastric bypass; Mesenteric defects closure; Peterson