Closure of Mesenteric Defects during Roux-en-Y Gastric Bypass Fails to Reduce Internal Herniation

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INTRODUCTION: The rising obesity rates have led to an increased demand for bariatric surgery, particularly laparoscopic Roux-en-Y gastric bypass (LRYGB). While effective, LRYGB carries risks such as internal herniation (IH). This study evaluates the impact of routinely closing mesenteric defects (MD) during LRYGB on IH incidence and postoperative outcomes in a high-volume bariatric center. METHODS: We conducted a retrospective cohort study of 6896 and 1903 LRYGB procedures before and after implementing routine MD closure respectively. We analyzed incidence of IH, kinking at the jejunojejunostomy (JJ), ICU admissions, hospital stay, postoperative pain relief, and the diagnostic value of CT scans. RESULTS: The incidence of IH in the closure group (2.84%) was not significantly different from the non-closure group (2.80%). Postoperative pain relief rates were similar between the groups. However, routine MD closure led to the occurrence of JJ kinking (0.84%), which was not present in the non-closure group, resulting in prolonged hospital stays and ICU admissions. CT scans were predictive for IH but had limitations. CONCLUSION: Routine closure of MD during LRYGB did not reduce IH incidence but introduced the new complication of JJ kinking. Postoperative pain relief rates were unaffected by MD closure. Our findings highlight the need for further research on alternative closure methods and improved diagnostic strategies to optimize surgical outcomes.

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