60 Mesenteric defect closure and the rate of internal hernia in laparoscopic Roux-en-Y gastric bypass: A systematic review and meta-analysis

Abstract

Abstract Introduction Laparoscopic Roux-en-Y gastric bypass (LRGB) is an increasingly popular operation as rates of obesity rise. Internal hernias pose a worrying complication. This meta-analysis aimed to determine if internal hernia rates were reduced by closure of the mesenteric defects at primary operation. Method A systematic review was performed identifying all observational and randomised studies comparing internal hernia rates in patients whose mesenteric defects were closed vs not closed during LRGB. Results 14 studies were included, totalling 20,553 patients undergoing LRGB. There was a significant reduction in internal hernia rate at both Petersen’s and the Jejunojejunostomy (J-J) defect when closed at operation. The rate of re-operation for suspected small bowel obstruction was also lower in the closure cohort. There was no difference in anastomotic leak or perioperative bleeding between closure and non-closure patients. Similar efficiency was observed when sutures were used to close the defects compared to clips and staples. Conclusion Mesenteric defect closure is reducing internal hernia rate as well as re-operation for suspected small bowel obstruction. The closure method of choice remains debatable, and further studies are required to determine this.