Laparoscopic Technique for Hernia Reduction and Mesenteric Defect Closure in Patients With Internal Hernia as a Postoperative Complication of Laparoscopic Roux-en-Y Gastric Bypass

We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett’s esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.

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Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial

Surgical Endoscopy ◽

10.1007/s00464-014-3970-3 ◽

2014 ◽

Vol 29 (9) ◽

pp. 2486-2490 ◽

Cited By ~ 23

Author(s):

Ulysses Rosas ◽

Shusmita Ahmed ◽

Natalia Leva ◽

Trit Garg ◽

Homero Rivas ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Gastric Bypass ◽

Controlled Trial ◽

Defect Closure ◽

Mesenteric Defect ◽

Randomized Controlled

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Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer

Surgical Endoscopy ◽

10.1007/s00464-019-06787-x ◽

2019 ◽

Vol 34 (1) ◽

pp. 436-442 ◽

Cited By ~ 3

Author(s):

Tetsuro Toriumi ◽

Rie Makuuchi ◽

Satoshi Kamiya ◽

Yutaka Tanizawa ◽

Etsuro Bando ◽

...

Keyword(s):

Gastric Cancer ◽

Risk Factor ◽

Internal Hernia ◽

Defect Closure ◽

Mesenteric Defect ◽

Robot Assisted

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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?

British Journal of Surgery ◽

10.1093/bjs/znab202.038 ◽

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.

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Impact of Mesenteric Defect Closure During Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): a Retrospective Study for a Total of 2093 LRYGB

Obesity Surgery ◽

10.1007/s11695-019-04000-5 ◽

2019 ◽

Vol 29 (10) ◽

pp. 3342-3347 ◽

Cited By ~ 9

Author(s):

Imed Ben Amor ◽

Radwan Kassir ◽

Tarek Debs ◽

Saud Aldeghaither ◽

Niccolo Petrucciani ◽

...

Keyword(s):

Gastric Bypass ◽

Retrospective Study ◽

Defect Closure ◽

Mesenteric Defect

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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?

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02180-2 ◽

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.

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