scholarly journals Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
R Schneider ◽  
M Schulenburg ◽  
M Kraljević ◽  
J M Klasen ◽  
T Peters ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Statistical Significance ◽  
Absorbable Suture ◽  
Defect Closure ◽  
Mesenteric Defect ◽  
Internal Hernias ◽  
Primary Surgery ◽  
Common Location ◽  
Observational Cohort

Abstract Objective Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Methods Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, 493 without jejunal mesenteric defect closure, 292 with closure by non-absorbable suture with a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel, as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Results By primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5% to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery could reduce the rate of IH from 5.3% to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. Conclusion The closure of the jejunal mesenteric defect by non-absorbable suture can reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, especially in patients with excellent weight loss. Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.

scholarly journals Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

2021 ◽  
Author(s):  
Romano Schneider ◽  
Michaela Schulenburg ◽  
Marko Kraljević ◽  
Jennifer M. Klasen ◽  
Thomas Peters ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Statistical Significance ◽  
Absorbable Suture ◽  
Defect Closure ◽  
Mesenteric Defect ◽  
Internal Hernias ◽  
Primary Surgery ◽  
Common Location ◽  
Observational Cohort

Abstract Purpose Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Methods Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, with 493 patients without jejunal mesenteric defect closure and 292 patients with closure by non-absorbable suture, and a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Results Through primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5 to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery reduced the rate of IH from 5.3 to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. Conclusion The closure of the jejunal mesenteric defect by non-absorbable suture may reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, particularly in patients with good weight loss. The Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.

Mesenteric Defect Closure Decreases the Incidence of Internal Hernias Following Laparoscopic Roux-En-Y Gastric Bypass: a Retrospective Cohort Study

2016 ◽  
Vol 26 (9) ◽  
pp. 2029-2034 ◽  
Author(s):  
Pradeep Chowbey ◽  
Manish Baijal ◽  
Nimisha S. Kantharia ◽  
Rajesh Khullar ◽  
Anil Sharma ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Defect Closure ◽  
Mesenteric Defect ◽  
Internal Hernias

scholarly journals P-B02 Does the length of  alimentary limb  make a significant difference  in the weight loss in  Roux en y gastric bypass patients?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mayank Bhandari ◽  
Sabyasachi Chowdhary ◽  
Milind Rao ◽  
Gopinath Bussa ◽  
Julie Holm
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Statistical Significance ◽  
Limb Length ◽  
Alimentary Limb ◽  
Significant Difference ◽  
Alimentary Limb Length ◽  
Biliopancreatic Limb ◽  
Group A ◽  
Group B

Abstract Background Roux en Y gastric bypass (RYGB) surgery for morbid obesity is considered as gold standard, but there can be a difference in the length of alimentary and biliopancreatic limb to achieve optimum weight loss. Till now there is no agreed consensus on the ideal limb lengths and their effect on the weight loss. We would like to evaluate the change in the alimentary limb length on the weight loss after the gastric bypass surgery,  as a short to medium term single center study. Methods A retrospective analysis from prospectively maintained   database of 523 patients who underwent RYGB from  2012 till 2018 was done. Patient who had at least a follow up of 2 years(n = 388) were included.  At our center we use alimentary limb of 120 +/- 10 cm for Body Mass Index (BMI) < 40 kg/m2 (group A)  and 150+/-10 cm for the BMI >40 kg/m2  (Group B). The biliopancreatic limb length varies from 50 to 70 cm and this does not change with BMI.  The percentage excess weight(EWL) loss was measured and analyzed  at 1st  and 2nd year post operatively. We used paired t test to check for statistical significance. Results There were 172 patients in Group A and 216 in Group B. The number of females were 330 and  males were 58.   The average age was 44 years .  The mean  preoperative  BMI for the 120 cm limb group was  37.1 kg/m2 and  that for  150 cm limb was 45.3kg/m2. The EWL for the group A at 1 year and 2 year post op was a  Mean and standard deviation  of 79.3% +/- 39.4% and 78.3% +/- 35.2% respectively and for group B was 58.8% +/- 26.6% and 58.6% +/- 23.2% respectively. The difference was statistically significant (p < 0.001) . The analysis and interpretation for metabolic syndrome is yet to be determined.   Conclusions In our study, Increasing the alimentary limb length for higher BMI reduced  EWL. This is consistent with few other publications regarding the same. This has resulted in a  change in our practice namely keeping the length of alimentary limb constant and varying the BP limb length. We will be analyzing  and presenting this data in future.

scholarly journals Impact of mesenteric defect closure technique on complications after gastric bypass

2018 ◽  
Vol 403 (4) ◽  
pp. 481-486 ◽  
Author(s):  
Erik Stenberg ◽  
Ingmar Näslund ◽  
Eva Szabo ◽  
Johan Ottosson
Keyword(s):  
Gastric Bypass ◽  
Defect Closure ◽  
Mesenteric Defect ◽  
Closure Technique

Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass

2011 ◽  
Vol 7 (2) ◽  
pp. 176-180 ◽  
Author(s):  
Nestor de la Cruz-Muñoz ◽  
Juan C. Cabrera ◽  
Melissa Cuesta ◽  
Scott Hartnett ◽  
Renan Rojas
Keyword(s):  
Gastric Bypass ◽  
Mesenteric Defect ◽  
Internal Hernias

scholarly journals Recurrent internal hernias after Roux-en-Y gastric bypass: An observational study in 1219 patients over 20 years

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
Y Fringeli ◽  
R Steffen ◽  
U Kessler ◽  
J Zehetner
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Laparoscopic Group ◽  
Small Bowel Resection ◽  
Median Percentage ◽  
Internal Hernias ◽  
Mesenteric Defects ◽  
Time Of Operation

Abstract Objective Internal hernia (IH) represents a well-known complication and the major cause of bowel obstruction after Roux-en-Y gastric bypass (RYGB) for morbid obesity. With the worldwide rise of performed RYGB, IH will become more frequent in the coming years. Lots of studies already addressed this issue to prevent its occurrence and improve its management. The aim of this study is to assess incidence and patterns of recurrence of IH. Methods A retrospective single-centre analysis was performed of prospectively collected follow-up data from patients who underwent a RYGB between January 2000 and December 2017 and who developed IH thereafter. Follow-up data were reviewed until December 2020. Both open (51) and laparoscopic procedures (1168) were included. All RYGB were performed using the antecolic technique with routine closure of the Petersen’s space (PS) and the mesenteric defect beneath the jejunojejunostomy (JJ). Only open mesenteric defects with incarcerated small bowel at the time of operation were considered as IH. Results One hundred thirty four patients presented with IH and all events occurred in the laparoscopic group (11.5%). Among the 134 patients with IH, a recurrence was observed in 35 patients (26.1%) after a median time of 13 months (range, 0-124) since the first IH. Seven patients presented more than 2 episodes of IH, among them one patient with 7 episodes. The median weight loss between the first and the second episode of IH was 0.0kg (range, -11.5-19.0) and the median percentage of excess weight loss achieved since the RYGB at the occurrence of the second IH was 97.2% (range, 55.3-111.2). Location of IH was PS in 70 patients (52.2%) at the time of the first IH and in 23 patients (65.7%) at the time of the second IH. Recurrence of IH at the same location was more frequent at the PS (22.9%) than at the JJ (10.9%). Overall, 185 operations for IH were performed, among them 132 (71.4%) laparoscopically. Only once, a small bowel resection was mandatory (0.5%). Conclusion For patients with laparoscopic RYGB, internal hernias represent a potential complication over a lifetime and have to be suspected even years after the index operation. One quarter of patients will develop a recurrence of IH and Petersen’s space is mostly involved.

scholarly journals Absorbable suture can be effectively and safely used to close the mesenteric defect in a Gastric bypass Sprague-Dawley Rat Model

2019 ◽  
Author(s):  
Libin Yao ◽  
Ponnie Robertlee Dolo ◽  
Yong Shao ◽  
Chao Li ◽  
Jason Widjaja ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Greater Omentum ◽  
Absorbable Suture ◽  
Mesenteric Defect ◽  
Absorbable Sutures ◽  
Group A ◽  
Prolene Suture ◽  
Group B ◽  
Mesenteric Defects ◽  
Group D

Abstract Background: To observe if closing the mesenteric defect with absorbable sutures creates a safe adhesion compared to non-absorbable suture after Roux-en-Y gastric bypass.Methods: Rats were randomly assigned to 5 experimental groups according to the different suture materials used in closing the mesenteric defects (Peterson’s space) after Roux-en-Y gastric bypass. Group A (control group), Group B (non-absorbable suture, Prolene suture), Group C (biological glue), Group D (non-absorbable suture, polyester suture) and Group E (absorbable suture). All rats were followed up for 8 weeks postoperatively and underwent laparotomy to observe the degree of adhesion and closure of the mesenteric defect.Results: No significant difference was found in the decrease in food intake and body weight among all groups. No internal hernia (IH) occurred in any group. The mesenteric defects of Group A remained completely visible without any closure or adhesion. Multiple gaps were found between the Prolene suture and the mesentery along the suture line in Group B. The mesenteric defects of Group C were complete closed with multiple adhesions of the small intestine and the greater omentum. The mesenteric defects in both Group D and Group E closed completely. The average adhesion scores in Group A and Group B were 0 and 0.33±0.52 respectively. The average adhesion score in group C (3.83±0.41) was higher than the other groups (p＜0.05). The average adhesion scores in Group D and E were similar (3.17±0.41 and 3.00±0.00 respectively). Conclusion: Absorbable suture created a safe adhesion score between the mesentery which was not inferior to non-absorbable sutures.

Intestinal Complications of Roux-en-Y Gastric Bypass

2018 ◽  
Author(s):  
Kevin D. Helling ◽  
Scott A. Shikora
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Signs And Symptoms ◽  
Bariatric Operation ◽  
Intestinal Volvulus ◽  
Vein Thrombosis ◽  
Internal Hernias ◽  
Anastomotic Strictures ◽  
Risk Patients

Roux-en-Y gastric bypass is a commonly performed bariatric operation, but it is a formidable procedure performed in technically challenging, medically high-risk patients. Although it is highly successful for achieving meaningful and durable weight loss, a variety of intestinal complications may occur. These include small bowel obstructions from a number of sources (internal hernias, adhesions, intussusception, incisional hernias, intestinal volvulus), anastomotic strictures, dumping syndrome, portal vein thrombosis, Roux-en-O construction, and small bowel diverticulitis. This chapter reviews several of the more commonly occurring postoperative intestinal complications. Clinicians need to understand the signs and symptoms of these complications and must be able to quickly diagnose the condition and initiate treatment.

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