Internal Hernias and Nonclosure of Mesenteric Defects During Laparoscopic Roux-en-Y Gastric Bypass

• Published in: Obesity surgery Vol. 19; no. 5; pp. 549 - 552
• Main Authors: Madan, Atul K., Lo Menzo, Emanuele, Dhawan, Naveen, Tichansky, David S.
• Format: Journal Article
• Language: English
• Published: New York Springer New York 01.05.2009; Springer Nature B.V
• Subjects: Clinical outcomes; Cohort Studies; Gastric Bypass - methods; Gastrointestinal surgery; Hernia, Abdominal - epidemiology; Hernias; Humans; Laparoscopy; Medicine; Medicine & Public Health; Mesentery - pathology; Mesentery - surgery; Morbidity; Obesity; Obesity, Morbid - complications; Obesity, Morbid - pathology; Obesity, Morbid - surgery; Reoperation; Research Article; Retrospective Studies; Risk Factors; Surgery; Suture Techniques; Time Factors; Laparoscopic gastric bypass; Laparoscopy; Roux-en-Y gastric bypass; Morbid obesity; Internal hernia; Bariatric surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-008-9722-5

Background Internal hernias have been described after laparoscopic Roux-en-Y gastric bypass (LRYGB) as a major problem. Thus, many routinely close defects during LRYGB. In our technique, we do not close any defects. We hypothesize that not closing the defects would not cause a significant internal hernia rate diagnosed during reoperations. Methods Patients who were reoperated after LRYGB were included in this study. Only patients who had a laparoscopic or open exploration focused on inspecting for internal hernias are reported here. The LRYGB technique that was utilized included an antecolic, antegastric gastrojejunostomy, minimal division of the small bowel mesentery, a long jejunojejunostomy performed with three staple lines, adequate division of the omentum, and placement of the jejunojejunostomy above the colon in the left upper quadrant. Results There were a total of 387 patients who had LRYGB from 2002 to 2007 utilizing this particular technique. Fifty-four patients had a reoperation at an average of 24 (Range: 1–60) months postoperatively. The procedures were abdominoplasty, cholecystectomy, diagnostic laparoscopy, and lysis of adhesions. While two patients had a defect present, no patient had an internal hernia despite aggressive attempts to diagnose one. Conclusions Internals hernias are not common after our particular method of LRYGB. Before adopting and advocating routine closure, surgeons should consider the surgical technique and the true associated incidence of internal hernias. We do not recommend routine closure of these defects with our technique.