Jorge Saba Samur1, Magdalena Bravo Hurtado2, Alberto Pérez-Castilla3, Eugenio Rivas Zapata3, Roberto Fernández Rodriguez3, Jorge Zajjur Castro4. 1. Service of Bariatric and Metabolic Surgery, Indisa Clinic, Santiago, Chile; Surgery Service, Dipreca Hospital, Santiago, Chile. Electronic address: doctor@jorgesaba.cl. 2. Surgery Service, Luis Tisné Hospital, Santiago, Chile. 3. Service of Bariatric and Metabolic Surgery, Indisa Clinic, Santiago, Chile; School of Medicine, Andrés Bello University, Indisa Clinic, Santiago, Chile. 4. Service of Bariatric and Metabolic Surgery, Indisa Clinic, Santiago, Chile.
Abstract
BACKGROUND: Internal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) to prevent IH in the LRYGB remains controversial. OBJECTIVES: The main objective of our study was to evaluate the risk of reopening at the level of both MDs, the Petersen space, and the intermesenteric gap. SETTING: University hospital. METHODS: Prospective cohort of patients with a history of LRYGB, all with closure of both MDs, and in whom another intra-abdominal surgery was performed after the LRYGB, between January 2013 and December 2018. The status of both MDs was recorded. All analyses were performed with Stata version 15 software with a level of significance of .05. RESULTS: A total of 76 patients were included. The average time that elapsed between the LRYGB and the surgery that evaluated the state of the MDs was 22.8 months. The patients lost on average 34.7 kg, with a minimum of 8 kg and a maximum of 76 kg. The indications for the interventions were cholelithiasis (68.3%), recurrent abdominal pain (13.2%), intestinal obstruction (11.8%), malabsorption syndrome (7.3%), and bilateral inguinal hernia (2.4%). At the time of surgery, 52 patients (68.4%) had a completely closed Petersen space; 58 patients (76.3%) had a completely closed intermesenteric defect. Both MDs were closed in 36 patients (47.4%), and 33 patients (43.4%) had at least 1 of the MDs open. CONCLUSION: The closure of MDs eliminated the risk of IH in half of the operated patients of LRYGB in this series.
BACKGROUND: Internal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) to prevent IH in the LRYGB remains controversial. OBJECTIVES: The main objective of our study was to evaluate the risk of reopening at the level of both MDs, the Petersen space, and the intermesenteric gap. SETTING: University hospital. METHODS: Prospective cohort of patients with a history of LRYGB, all with closure of both MDs, and in whom another intra-abdominal surgery was performed after the LRYGB, between January 2013 and December 2018. The status of both MDs was recorded. All analyses were performed with Stata version 15 software with a level of significance of .05. RESULTS: A total of 76 patients were included. The average time that elapsed between the LRYGB and the surgery that evaluated the state of the MDs was 22.8 months. The patients lost on average 34.7 kg, with a minimum of 8 kg and a maximum of 76 kg. The indications for the interventions were cholelithiasis (68.3%), recurrent abdominal pain (13.2%), intestinal obstruction (11.8%), malabsorption syndrome (7.3%), and bilateral inguinal hernia (2.4%). At the time of surgery, 52 patients (68.4%) had a completely closed Petersen space; 58 patients (76.3%) had a completely closed intermesenteric defect. Both MDs were closed in 36 patients (47.4%), and 33 patients (43.4%) had at least 1 of the MDs open. CONCLUSION: The closure of MDs eliminated the risk of IH in half of the operated patients of LRYGB in this series.