Failure of Mesenteric Defect Closure After Roux-en-Y Gastric Bypass

Abstract

Routine closure of mesenteric defects after Roux-en-Y gastric bypass may not be an effective permanent closure.

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

“…Weight loss is considered a risk factor for internal hernia in RYGBP [15,16]. The large decrease in mesenteric fat after distal gastrectomy is a major cause of weight loss after surgery [17,18]. As a result, a large weight loss may increase the size of the mesenteric defect, thus accelerating the internal hernia [19].…”

Re-do Roux-en-Y Gastric Bypass in a Patient with Known Midgut Malrotation

“…There is no consensus in the literature about whether the closure of mesenteric defects is effective. 15,16 In our literature review, four case reports mentioned that the mesenteric defect was closed but the remaining reports did not comment on whether it was performed. 4,17–19 In our practice we close the mesenteric defect at the jejuno-jejunostomy with continuous nonabsorbable sutures.…”

Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis

“…5,13 Indeed a number of studies have documented a decrease in the incidence of internal hernias and small bowel obstructions after antecolic Roux limb placement (0.43% to 3.3%) compared with retrocolic (4.5% to 7%). 6 Hwang et al reported their experience and compared their results with both the antecolic and retrocolic routes. They reported a decrease in the incidence of SBO to 2% which was significant with the antecolic route.…”

“…Controversy continues as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after RYGB. 6 The clinical presentation of an IH can vary from atypical and intermittent symptoms to a dramatic acute abdomen secondary to small bowel necrosis or perforation. Three potential hernia sites exist after RYGB.…”