Abstract
IntroductionClosure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass surgery (RYGB) has not been fully established as standard operative practice. However, in recent years a body of evidence has emerged suggesting that non-closure of defects leads to increased rates of internal herniation and its potential consequences, including the need for reoperation, along with an associated morbidity and mortality risk. Within the emerging literature there has also been some evidence of a greater risk of 30-day complications in closure groups. This systematic review and meta-analysis aims to look at the existing evidence and provide guidance on whether closure of mesenteric defects should be standard operative practice. MethodsThe systematic review and meta-analysis has been registered a priori. A literature search will be performed interrogating the Medline and Embase databases via Ovid, and also the Cochrane Controlled Register of Trials (CENTRAL), to identify randomised and non-randomised studies reporting comparative outcomes following closure vs. non-closure of mesenteric defects during RYGB. The primary outcome will be reoperation for small bowel obstruction, and secondary outcomes will include internal herniation, jejuno-jejunal anastomosis narrowing or kinking, adhesions, complications (<30 days and >30 days after surgery), 30-day mortality, reoperation, and any other outcome deemed relevant and reported in more than one study.
Highlights
Closure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass surgery (RYGB) has not been fully established as standard operative practice
Small bowel internal herniation may occur through the retroalimentary space, through the mesojejunal defect created by the jejuno-jejunal anastomosis, or through the transmesocolic space, and can lead to potentially life-threatening small bowel obstruction, ischaemia and necrosis
It is essential to document and take account of the extent of excess complications associated with closure of mesenteric defects, such as early reoperation for bleeding and small bowel obstruction
Summary
Metabolic/bariatric surgery (MBS) has become an important and highly effective treatment in the management of obesity and its related diseases, such as hypertension and type 2 diabetes. Several types of bariatric procedure exist and laparoscopic Roux-en-Y gastric bypass (RYGB) has remained a popular choice, with impressive endurance and comorbidity resolution [3]. Small bowel internal herniation may occur through the retroalimentary space, through the mesojejunal defect created by the jejuno-jejunal anastomosis, or through the transmesocolic space, and can lead to potentially life-threatening small bowel obstruction, ischaemia and necrosis. Several studies have suggested that the routine primary closure of these mesenteric defects may decrease the rates of internal hernia, but this practice is currently not routinely adopted worldwide
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