Internal Hernia After Laparoscopic Gastric Bypass: Effect of Closure of the Petersen Defect - Single-Center Study

Blockhuys, Magali; Gypen, Bart; Heyman, Stijn; Valk, Jody; Sprundel, Frank van; Hendrickx, L.

doi:10.1007/s11695-018-3472-9

Cited by 34 publications

(16 citation statements)

References 13 publications

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“…sufficient. A large retrospective series strongly supports the recommendation to close the jejunal mesenteric defect and the Petersen space (between the AL and the transverse mesocolon) [19]. Also, in a meta-analysis performed by Geubbels et al, the combination of jejunal mesenteric space and Petersen space closure seems to generate the lowest rates of IH in the long-term [10].…”

Section: Introductionmentioning

confidence: 68%

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

Schneider

Schulenburg

Kraljević

et al. 2021

Langenbecks Arch Surg

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Purpose Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Methods Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, with 493 patients without jejunal mesenteric defect closure and 292 patients with closure by non-absorbable suture, and a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Results Through primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5 to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery reduced the rate of IH from 5.3 to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. Conclusion The closure of the jejunal mesenteric defect by non-absorbable suture may reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, particularly in patients with good weight loss. The Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.

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Section: Introductionmentioning

confidence: 68%

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

Schneider

Schulenburg

Kraljević

et al. 2021

Langenbecks Arch Surg

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“…Various techniques of closure have been described, including different types of suture (either with absorbable or nonabsorbable material), the use of staplers and of fibrin sealant reinforcements [10,[23][24][25]. Several authors reported a decreased rate of IH with mesenteric defects closure [5,13,14,26,27]. On the other hand, closure of the mesenteric defects was associated with higher risk of complications such as bleeding due to injury of the mesenteric vessels, and kinking of the anastomosis leading to small bowel obstruction [13,28,29].…”

Section: Discussionmentioning

confidence: 99%

Robotic “Double Loop” Roux-en-Y gastric bypass reduces the risk of postoperative internal hernias: a prospective observational study

et al. 2020

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Background Internal herniation (IH) is a potentially serious complication after laparoscopic Roux-en-Y gastric bypass (RYGB). The aim of the study is to evaluate the incidence of IH after robot-assisted RYGB (RA-RYGB) performed with the "Double Loop" technique at our Institution. Methods Prospective cohort study of patients submitted to RA-RYGB with the "Double Loop" technique, with a minimum follow-up of 2 years. Patients with complaints of abdominal pain at clinical visits or entering the emergency department were evaluated. Primary outcome was the incidence of IH, defined as the presence of herniated bowel through a mesenteric defect, diagnosed at imaging or at surgical exploration. Results A total of 129 patients were included: 65 (50.4%) were primary procedures, while 64 (49.6%) were revisional operations after primary restrictive bariatric surgery. Mean age was 47.9 ± 10.2 years, mean weight, and body mass index were, respectively, 105.3 ± 22.6 kg and 39.7 ± 9.6 kg/m 2. Postoperative morbidity rate was 7.0%. Mean follow-up was 53.2 ± 22.6 (range 24-94) months. During the follow-up period, a total of 14 (10.8%) patients entered the emergency department: 1 patient had melena, 4 renal colic, 1 acute cholecystitis, 2 gynecologic pathologies, 2 anastomotic ulcers, 1 perforated gastric ulcer, 1 diverticulitis and 2 gastroenteritis. There were no diagnoses of IH. During the follow-up period, no patient experienced recurrence of symptoms. Conclusions In the present study, the robotic approach confirms the low complication rate and absence of IH after "Double Loop" RA-RYGB in a large case-series at a medium-term follow-up.

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“…An internal hernia can lead to small bowel obstruction and life-threatening conditions, such as bowel ischemia or perforation [1,2]. Internal hernia is a recognized and well-described complication after laparoscopic Roux-Y gastric bypass [3][4][5][6]. However, there have been few studies about internal hernia after gastrectomy for gastric cancer [1,7], and to our knowledge, there has been no study on Petersen's hernia (PH) after gastrectomy for gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

Closure of Petersen’s defect in gastrectomy for gastric cancer: an interrupted time series analysis from a high-volume institution in China

Wang

Liu

Chen

et al. 2020

Langenbecks Arch Surg

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Purpose Petersen’s hernia (PH) is a serious complication after gastrectomy for gastric cancer. The aim of this study was to investigate whether closure of Petersen’s defect (PD) can decrease the rates of PH and suspected Petersen’s hernia (SPH). Methods Patients who underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without PD closure (non-closure group). From February 2017 to June 2018, we closed PDs during gastrectomy (closure group). The rates of PH and SPH were compared between the two groups. The last follow-up was updated in August 2020. Results Among a total of 1213 patients, 12 patients (1.0%) developed PH, and 23 patients (1.9%) developed SPH. The rate of PH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 11/828, 1.3%, p = 0.042, log-rank test). The rate of SPH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 22/828, 2.7%, p = 0.008, log-rank test). Non-closure of PD was a risk factor for PH and SPH (odds ratio (OR) 7.72, 95% CI 1.84–32.35, p = 0.006). Conclusions PD closure is recommended after gastrectomy for gastric cancer, as the rates of PH and SPH were significantly decreased.

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Internal Hernia After Laparoscopic Gastric Bypass: Effect of Closure of the Petersen Defect - Single-Center Study

Abstract: After descriptive analysis, these results can provide strong recommendation of closure of the mesenteric defect and Petersen's space, as we notice a tendency to lower incidence of internal hernias.

Cited by 34 publications

References 13 publications

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

Robotic “Double Loop” Roux-en-Y gastric bypass reduces the risk of postoperative internal hernias: a prospective observational study

Closure of Petersen’s defect in gastrectomy for gastric cancer: an interrupted time series analysis from a high-volume institution in China

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