Ioannis I Lazaridis1, Thomas Köstler2, Lukas Kübler3, Urs Zingg2, Tarik Delko4. 1. Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland. 2. Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland. 3. Medical Faculty, University of Basel, 4056, Basel, Switzerland. 4. Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland. tarik.delko@clarunis.ch.
Abstract
PURPOSE: Small bowel obstruction (SBO) due to internal hernias (IH) is a well-recognised complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Routine closure of the mesenteric defects (MDs) is recommended to reduce the risk of IH and subsequent SBO. However, data about the rates of reopening of the MDs after LRYGB is scarce. The main aim of this study was to evaluate the risk of reopening of the MDs after routine closure during LRYGB. The secondary objective was to determine any risk factors associated with the reopening of the MDs. METHODS: Data of all patients who underwent reoperations after LRYGB with closure of both MDs between January 2010 and December 2018 were retrospectively reviewed. RESULTS: A total of 162 patients were included. The median time between LRYGB and reoperation was 17 months. At the time of reoperation, both MDs were closed in 83 patients (51.2%); thus, 79 patients (48.8%) presented at least one open MD. The group of patients with preoperative diagnosis of SBO or with recurrent abdominal pain showed significantly higher rates of open Petersen's space compared to the group of patients with other preoperative diagnoses. Preoperative body mass index (BMI) less than 40 kg/m2 at time of LRYGB was associated with a higher risk for an open MD. CONCLUSION: At least one MD reopened in almost half of the patients despite routine closure during LRYGB. Therefore, the status of MDs should be routinely examined during every reoperation after LRYGB and closure of open MDs should be performed.
PURPOSE: Small bowel obstruction (SBO) due to internal hernias (IH) is a well-recognised complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Routine closure of the mesenteric defects (MDs) is recommended to reduce the risk of IH and subsequent SBO. However, data about the rates of reopening of the MDs after LRYGB is scarce. The main aim of this study was to evaluate the risk of reopening of the MDs after routine closure during LRYGB. The secondary objective was to determine any risk factors associated with the reopening of the MDs. METHODS: Data of all patients who underwent reoperations after LRYGB with closure of both MDs between January 2010 and December 2018 were retrospectively reviewed. RESULTS: A total of 162 patients were included. The median time between LRYGB and reoperation was 17 months. At the time of reoperation, both MDs were closed in 83 patients (51.2%); thus, 79 patients (48.8%) presented at least one open MD. The group of patients with preoperative diagnosis of SBO or with recurrent abdominal pain showed significantly higher rates of open Petersen's space compared to the group of patients with other preoperative diagnoses. Preoperative body mass index (BMI) less than 40 kg/m2 at time of LRYGB was associated with a higher risk for an open MD. CONCLUSION: At least one MD reopened in almost half of the patients despite routine closure during LRYGB. Therefore, the status of MDs should be routinely examined during every reoperation after LRYGB and closure of open MDs should be performed.
Authors: Richard Welbourn; Marianne Hollyman; Robin Kinsman; John Dixon; Ronald Liem; Johan Ottosson; Almino Ramos; Villy Våge; Salman Al-Sabah; Wendy Brown; Ricardo Cohen; Peter Walton; Jacques Himpens Journal: Obes Surg Date: 2018-11-12 Impact factor: 4.129
Authors: Erik Stenberg; Eva Szabo; Göran Ågren; Johan Ottosson; Richard Marsk; Hans Lönroth; Lars Boman; Anders Magnuson; Anders Thorell; Ingmar Näslund Journal: Lancet Date: 2016-02-16 Impact factor: 79.321
Authors: Frederiek Nuytens; Mathieu D'Hondt; Frank Van Rooy; Franky Vansteenkiste; Hans Pottel; Mohammed Abasbassi; Ann Servaege; Dirk Devriendt Journal: Int J Surg Date: 2019-09-19 Impact factor: 6.071