SP6.1.10 Prevention of internal hernia by closure versus non-closure of the mesenteric defect in patients undergoing Roux-en-Y gastric bypass- a meta-analysis of published randomized controlled trials

Abstract

Objective The objective of this article is to evaluate the prevention of internal hernia by mesenteric defect closure (MDC) versus non-closure of the mesenteric defect (MDNC) in patients undergoing Roux-en-Y gastric bypass. Method Standard medical electronic databases were searched, and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcome of post-operative surgical variables including the incidence of internal hernia were analyzed using principles of meta-analysis on RevMan 5 statistical software. Result Five RCTs on 3285 patients undergoing Roux-en-Y gastric bypass operation for any indication or approach were found suitable for meta-analysis. There were 1635 patients in the MDC group and 1650 patients in the MDNC group. The duration of the operation was statistically longer in MDC [random effects model, standardized mean difference (SMD) 0.73, 95% CI (0.22–1.25), z=2.78, p=0.005]. There was no statistical difference related to length of hospital stay [random effects model, standardized mean difference (SMD) 0.15, 95% CI (-0.41, 0.44), z= 1.01; P= 0.31] between the two groups. The incidence of internal hernia was significantly reduced in MDC group. This difference was statistically significant [random effects model, odds ratio 0.36, 95% CI (0.19–0.66), z=3.27, p=0.001]. However, there was significant statistical heterogeneity (Chi2= 31.99, df = 4 (P < 0.00001) among included RCTs. Conclusion The routine closure of mesenteric defect in patients undergoing Roux-en-y bypass may be an effective approach to reduce the risk of internal hernia. However, more RCTs of robust quality recruiting higher number of patients are required to validate these findings.