ROUTINE CLOSURE OF MESENTERIC DEFECTS IN RETROCOLIC ANTEGASTRIC LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: NO INTERNAL HERNIA DEVELOPED IN 190 CONSECUTIVE CASES

Guang-Wei Wang, Zhong-Qi Mao^*

Department of Mini-mally Invasive Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China

Objective: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasingly a common procedure of choice in bariatric surgery. Internal hernia after LRYGB is a serious complication leading to rise in patient’s morbidity and mortality. But the closure of the mesenteric defects remains a subject of controversy. The aim of this study is to evaluate the results of routine closure of mesenteric defects in retrocolic antegastric LRYGB.

Methods: Clinical data of patients underwent LRYGB in the First Affiliated Hospital of Soochow University between June 2011 and June 2014 were reviewed. All the patients had retrocolic and antegastric anastomosis as a standard procedure with linear stapling. The jejunojejunal anastomotic mesenteric defect and Peterson’s defect were routinely closed by interrupted permanent suture. The patients were follow-up at 1, 3, 6 , 12 months and annually thereafter.

Results: 190 LRYGB were performed. There were 126 males and 64 females with mean age of 30.4 years (range, 18-59), mean preoperative BMI 42.7 (range, 28.3-79.2), mean operating time 128 minutes (range, 103-140). All the patients had at least 12 months follow-up. Percentage of excess weight loss in 1, 3, 6, and 12 month after operation were 28.3±8.2%, 54.6±7.9%, 76.5±7.3%, 81.4±8.6%, respectively. No any patient (0%) developed internal hernia postoperatively. No any severe complications and death cases were observed.

Conclusions: Routine closure of mesenteric defects in LRYGB does not increase much operating time. There are patient benefits if the mesenteric defects are properly closed. Randomized control trial is needed to verify the long term outcomes.