Year-end Sale % OFF 
Abstract
BackgroundInternal hernias occur after Roux-en-Y gastric bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created. The closure technique used is related to the internal hernia risks outcomes. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. By closing over a BIO mesh, the risk might be reduced even more.SettingTwo large private hospitals specialized in bariatric surgery.MethodsAll patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In all patients, the entero-enterostomy (EE) was closed using a double layered non-absorbable suture. In 2014, Petersen’s space was closed exclusively using glue, the years hereafter in a similar fashion as the EE, combined with a piece of glued BIO Mesh.ResultsThe glued RYGB patients showed 25% of patients with an internal hernia (14%) or open Petersen’s space compared to 0.5% of patients (p < 0.001) who had a combined sutured and BIO Mesh Closure of their Petersen’s space defect. Although this was an ideal technique for Petersen’s space, it led to 1% of entero-enterostomy kinking due to the firm adhesion formation.ConclusionGluing the intermesenteric spaces is not beneficial but placing a BIO Mesh in Petersen’s space is a promising new technique to induce local adhesions. It is above all safe, effective and led to an almost complete reduction of Petersen’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture should give more insights into which is the optimal closure technique.
Highlights
Internal hernias occur after Roux-en-Y gastric bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created
The techniques described in literature all use a mechanical method, but why not induce local adhesions that have proven to lead to less internal hernias (IH)? This study reports on a novel technique and compares between the closure of Petersen’s space using glue alone vs Suture closure with a 3′0 Novafil v lock, reinforced with Bio A mesh (GORE® BIO-A®) to induce local adhesions
Patient who underwent a Ante Colic RYGB (ACRYGB) at the Warringal or Knox Private Hospital (Melbourne Australia), between January 2014 and July 2018 were included for this study
Summary
Internal hernias occur after Roux-en-Y gastric bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created. The closure technique used is related to the internal hernia risks outcomes. These complaints have multiple origins, which range from obstipation to bacterial overgrowth. It seems that internal hernias (IH) are perhaps the biggest contributor. An IH can occur at any time after RYGB but the highest risk is when the maximum of weight loss has occurred. This is between the first and the second year. IHs continue to be a problem after Laparoscopic Ante Colic RYGB (ACRYGB).
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
