The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass\u2014a Post Hoc Analysis of a Randomized Clinical Trial

Demir Amanda,Norrman Eva,Påhlson Elin,Erik Stenberg

doi:10.1007/s11695-021-05778-z

Abstract

BackgroundAbdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common and unwanted complication that typically leads to further exploration through radiology. Concerns have been raised regarding the consequences of this radiation exposure and its correlation with the lifetime risk of cancer. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses.MethodsThis subgroup analysis included 300 patients randomized to either closure (n = 150) or nonclosure (n = 150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first 5 postoperative years was recorded together with the radiological findings and radiation doses.ResultsA total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p = 0.014). The other pathological and radiological findings were infrequent and not significantly different between groups. At the 5-year follow-up, the total radiation dose was 82,400 mGy cm in the nonclosure group and 85,800 mGy cm in the closure group.ConclusionClosure of mesenteric defects did not influence the use of CT to assess abdominal pain.Graphical abstract

Highlights

Obesity is associated with a wide range of negative health effects such as sleep apnea, hypertension, depression, diabetes, cardiovascular disease, and cancer [1]
All CT scans acquired for any symptoms of abdominal pain within the first 5 postoperative years were obtained from the regional hospital database and collected together with the indications for the examination, radiological findings, and radiation exposure, as measured by doselength product (DLP, in mGy cm) and computed tomography dose index (CTDI, in mGy)
300 patients agreed to participate in the study and were randomized in equal proportions for either mesenteric defect closure using running nonabsorbable sutures or nonclosure

Summary

Introduction

Obesity is associated with a wide range of negative health effects such as sleep apnea, hypertension, depression, diabetes, cardiovascular disease, and cancer [1]. This condition is a rapidly increasing concern of the modern world, and surgical treatment, with gastric bypass as a viable option, is currently the best way to achieve long-term results [2]. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses. Conclusion Closure of mesenteric defects did not influence the use of CT to assess abdominal pain

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