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Vuagniaux A, Barberá-Carbonell B, Dayer A, Mantziari S, Suter M. Meticulous Closure of Mesenteric Defects Effectively Reduces the Incidence of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2024:10.1007/s11695-024-07306-1. [PMID: 38902480 DOI: 10.1007/s11695-024-07306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Internal hernia (IH) after Roux-Y gastric bypass (RYGB) can lead to extended small bowel ischemia if it not recognized and treated promptly. The aim of this study is to show whether improvement in mesenteric defect (MD) closure reduces the incidence of IH. PATIENTS AND METHODS Retrospective analysis of prospectively collected data from our database including all patients who underwent laparoscopic RYGB between 1999 and 2015. The usual technique was a retrocolic/retrogastric RYGB. We divided patients in four groups according to the closure technique for MD and compared incidences of IH between groups. All patients had at least 8 years of follow-up. RESULTS A total of 1927 patients (1497 females/460 males, mean age of 41.5 ± 11 years) were operated. A retrocolic/retrogastric RYGB was performed in 1747 (90.7%) and an antecolic RYGB in 180 patients. Mean duration of follow-up was 15 (8-24) years. 111 patients (5.8%) developed IH, the majority through the jejunojejunostomy (JJ, 3.7%) and Petersen (1.7%) defects. With improvement of closure technique, the incidence decreased over time, from 12.9% in the group with separate sutures to 1.05% in the most recent group with running non-absorbable sutures and an additional purse-string at the JJ defect (p < 0.0001). CONCLUSION Meticulous closure of MD during RYGB is a very important step that significantly reduces the IH risk after RYGB, even with a retrocolic/retrogastric anatomy. Using running non absorbable braided sutures and an additional purse-string suture at the JJ is the most effective technique, but a small IH risk persists. A high index of suspicion remains necessary in patients who present with acute abdominal pain after RYGB.
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Affiliation(s)
- Aurélie Vuagniaux
- Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | | | - Anna Dayer
- Department of Surgery, Riviera-Chablais Hospital, Centre Médico-Chirurgical de L'Obésité Riviera-Chablais, Rte Des Tilles 6A, 1847, Rennaz, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland.
- Department of Surgery, Riviera-Chablais Hospital, Centre Médico-Chirurgical de L'Obésité Riviera-Chablais, Rte Des Tilles 6A, 1847, Rennaz, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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2
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Zhang M, Fan Y, Li J, Yong L. Petersen's hernia after gastric cancer surgery: Unravelling clinical characteristics and optimal management approaches. J Minim Access Surg 2024:01413045-990000000-00047. [PMID: 38557483 DOI: 10.4103/jmas.jmas_315_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/22/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Petersen's hernia is a rare and serious complication that can occur after radical gastrectomy and digestive tract reconstruction for gastric cancer. This article summarises the symptoms, diagnosis and treatment of Petersen's hernia after surgery for gastric cancer. PATIENTS AND METHODS A retrospective analysis was conducted on 11 male patients who were diagnosed with Petersen's hernia and underwent surgical treatment at our hospital from January 2020 to December 2022. Their clinical manifestations, perioperative conditions and follow-up after treatment were collected. RESULTS The median age was 58.5 years (range: 45-73), and the median time since gastrectomy was 24 months (range: 4-125). Open distal gastrectomy (45.5%) and open total gastrectomy (27.3%) were the most common procedures. Roux-en-Y (81.8%) was the predominant anastomosis method. All patients underwent emergency surgery within a median time of 30 h (range: 4-45). Intestine necrosis occurred in 36.4% of cases, with a perioperative death rate of 27.3%. CONCLUSION Petersen's hernia after gastric cancer surgery can quickly lead to necrotising intestinal obstruction and poor prognosis. Enhanced abdominal computed tomography should be performed as soon as possible, and early exploratory laparotomy should be done to avoid intestinal necrosis. Routine closure of the mesenteric defect after gastric cancer resection can prevent the occurrence of Petersen's hernia. This article highlights the need for increased awareness and preventive measures to minimise the occurrence of Petersen's hernia in gastric cancer patients. It emphasises the importance of early detection and appropriate management strategies for improved patient outcomes.
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Affiliation(s)
- Mingran Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Yue Fan
- Department of Blood Transfusion, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Jun Li
- Department of Gastrointestinal Surgery, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Liu Yong
- Department of Gastrointestinal Surgery, People's Hospital of Deyang City, Deyang, Sichuan, China
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Bruinsma FFE, van der Burg SJC, El Adel S, Schouten R, Smeets SJM. Quality of stapled mesenteric defect closure influences the chance of reopening after laparoscopic Roux-en-Y gastric bypass surgery. Updates Surg 2024:10.1007/s13304-024-01751-4. [PMID: 38332391 DOI: 10.1007/s13304-024-01751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024]
Abstract
Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen's space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2-53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8-16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique.
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Affiliation(s)
- F F E Bruinsma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
| | - S J C van der Burg
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - S El Adel
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - R Schouten
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - S J M Smeets
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
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Park JK, Kim DH, Jeon TY, Jeong SH, Kim TH, Min JS, Kim RB, Lee YJ, Park JH, Son YG, Yoon KY, Seo KW, Kim KH, Kim Y, Chae HD, Hwang SH, Lee SH, Chung JH, Kim HI, Park DJ, Kim KH, Seo SH, Oh SJ, Lee WY, In Choi C. Comparison between the mesenteric fixation method (MEFIX) and conventional methods at preventing the occurrence of Petersen's hernia: a study protocol for a multicenter randomized controlled trial. Trials 2024; 25:7. [PMID: 38167216 PMCID: PMC10759566 DOI: 10.1186/s13063-023-07841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Petersen's hernia, which occurs after Billroth-II (B-II) or Roux-en-Y (REY) anastomosis, can be reduced by defect closure. This study aims to compare the incidence of bowel obstruction above Clavien-Dindo classification grade III due to Petersen's hernia between the mesenteric fixation method and the conventional methods after laparoscopic or robotic gastrectomy. METHODS This study was designed as prospective, single-blind, non-inferiority randomized controlled multicenter trial in Korea. Patients with histologically diagnosed gastric cancer of clinical stages I, II, or III who underwent B-II or REY anastomosis after laparoscopic or robotic gastrectomy are enrolled in this study. Participants who meet the inclusion criteria are randomly assigned to two groups: a CLOSURE group that underwent conventional Petersen's defect closure method and a MEFIX group that underwent the mesenteric fixation method. The primary endpoint is the number of patients who underwent surgery for bowel obstruction caused by Petersen's hernia within 3 years after laparoscopic or robotic gastrectomy. DISCUSSION This trial is expected to provide high-level evidence showing that the MEFIX method can quickly and easily close Petersen's defect without increased postoperative complications compared to the conventional method. TRIAL REGISTRATION ClinicalTrials.gov NCT05105360. Registered on November 3, 2021.
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Affiliation(s)
- Jae Kyun Park
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea
| | - Dae Hwan Kim
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea
| | - Tae-Yong Jeon
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Republic of Korea
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young Gil Son
- Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Ki Young Yoon
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Ki Hyun Kim
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yoonhong Kim
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Hyun Dong Chae
- Department of Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sun Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Si-Hak Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jae Hun Chung
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Jin Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kwang Hee Kim
- Department of Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sang Hyuk Seo
- Department of Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung Jin Oh
- Department of Surgery, Inje University Haeundae Paik Hospital , Busan, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Inje University Haeundae Paik Hospital , Busan, Republic of Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Institution, Busan, 49241, Republic of Korea.
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Muir D, Choi B, Clements C, Ratnasingham K, Irukulla S, Humadi S. Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis. Obes Surg 2023; 33:2229-2236. [PMID: 37162714 DOI: 10.1007/s11695-023-06597-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples.
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Affiliation(s)
- Duncan Muir
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK.
| | - Byung Choi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | - Shashi Irukulla
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Samer Humadi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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Altieri MS, Carter J, Aminian A, Docimo S, Hinojosa MW, Cheguevara A, Campos GM, Eisenberg D. American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:763-771. [PMID: 37268518 DOI: 10.1016/j.soard.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jonathan Carter
- Department of General Surgery, University of California, San Francisco, California
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Salvatore Docimo
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Afaneh Cheguevara
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California
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7
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Leitman IM. Closure of Mesenteric Defects During Gastric Bypass Reduces but Does Not Eliminate the Risk of Internal Hernia. JAMA Surg 2023:2804887. [PMID: 37163256 DOI: 10.1001/jamasurg.2023.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Diagnosis and prevention of internal abdominal hernia after laparoscopic-assisted gastrectomy. Asian J Surg 2023; 46:1392. [PMID: 36123206 DOI: 10.1016/j.asjsur.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022] Open
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Verrelst L, Blockhuys M, Hendrickx L, Gypen B, Valk J, Heyman S, Vervloessem D, van Sprundel F. Effect of Suture Used for Closure of Mesenteric Defects After Laparoscopic Roux-en-Y Gastric Bypass: Single-Center Study. Obes Surg 2023; 33:506-512. [PMID: 36564621 DOI: 10.1007/s11695-022-06411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Small bowel obstruction (SBO) due to internal herniation (IH) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study is to evaluate different types of non-absorbable sutures used for closure of the defects regarding the incidence of SBO due to IH/adhesions, adhesion formation in general, or reopening of the defects. METHODS A single-center retrospective study was performed. Patients who underwent LRYGBP were divided in 3 groups: group A closure of the defects with monofilament Polypropylene suture (Prolene®), group B with braided polyester suture (Ethibond®), group C with barbed knotless Polybutester suture (V-Loc®). Descriptive statistics were performed regarding SBO due to IH/adhesions, adhesion formation, and reopening of closed defects. RESULTS From 5145 patients, 224 patients underwent exploratory laparoscopy for suspicion of SBO. Mean time interval was 28.4 months. IH or intermittent IH was found in 1.94% in group A, 1.78% in group B, and 1.40% in group C. Obstruction due to adhesions was found in 0.70%, 0.36%, and 0.42% per group, respectively. Adhesions in general were observed in 1.47% in group A, 1.43% in group B, and 1.06% in group C. The incidence of reopening was higher in group A (2.24%) in comparison with group B (1.13%, P = 0.041) and group C (1.05%, P = 0.001). CONCLUSIONS After descriptive analysis, these results can withhold no difference among the 3 non-absorbable sutures regarding incidence of SBO due to IH or SBO due to adhesions, yet tendency for higher reopening rates after closure with monofilament Polypropylene suture is observed.
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Affiliation(s)
- Lynn Verrelst
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Magali Blockhuys
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Leo Hendrickx
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Bart Gypen
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Jody Valk
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Stijn Heyman
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Dirk Vervloessem
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Frank van Sprundel
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
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Apostolou KG, Lazaridis II, Kanavidis P, Triantafyllou M, Gkiala A, Alexandrou A, Ntourakis D, Delko T, Schizas D. Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:49. [PMID: 36662172 DOI: 10.1007/s00423-023-02798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the actual incidence of symptomatic Petersen's hernias (PH) as well as identify risk factors for their occurrence. METHODS Search was performed in Medline (via PubMed), Web of Science, and Cochrane library, using the keywords "Petersen Or Petersen's AND hernia" and "Internal hernia." Only studies of symptomatic PH were eligible. Fifty-three studies matched our criteria and were included. Risk of bias for each study was independently assessed using the checklist modification by Hoy et al. Analysis was performed using random-effects models, with subsequent subgroup analyses. RESULTS A total of 81,701 patients were included. Mean time interval from index operation to PH diagnosis was 17.8 months. Total small bowel obstruction (SBO) events at Petersen's site were 737 (0.7%). SBO incidence was significantly higher in patients without defect closure (1.2% vs 0.3%, p < 0.01), but was not significantly affected by anastomosis fashion (retrocolic 0.7% vs antecolic 0.8%, p = 0.99). SBO incidence was also not significantly affected by the surgical approach (laparoscopic = 0.7% vs open = 0.1%, p = 0.18). However, retrocolic anastomosis was found to be associated with marginally, but not significantly, increased SBO rate in patients with Petersen's space closure, compared with the antecolic anastomosis (p = 0.09). CONCLUSION PH development may occur after any gastric operation with gastrojejunal anastomosis. Contrary to anastomosis fashion and surgical approach, defect closure was demonstrated to significantly reduce SBO incidence. Limitations of this study may include the high heterogeneity and the possible publication bias across the included studies.
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Affiliation(s)
- Konstantinos G Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece.
| | - Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Prodromos Kanavidis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Margarita Triantafyllou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Anastasia Gkiala
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | | | - Tarik Delko
- Chirurgie Zentrum St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
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Risk of Reopening of the Mesenteric Defects After Routine Closure in Laparoscopic Roux-en-Y Gastric Bypass: a Single-Centre Experience. Obes Surg 2022; 32:2853-2859. [PMID: 35760981 DOI: 10.1007/s11695-022-06179-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Small bowel obstruction (SBO) due to internal hernias (IH) is a well-recognised complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Routine closure of the mesenteric defects (MDs) is recommended to reduce the risk of IH and subsequent SBO. However, data about the rates of reopening of the MDs after LRYGB is scarce. The main aim of this study was to evaluate the risk of reopening of the MDs after routine closure during LRYGB. The secondary objective was to determine any risk factors associated with the reopening of the MDs. METHODS Data of all patients who underwent reoperations after LRYGB with closure of both MDs between January 2010 and December 2018 were retrospectively reviewed. RESULTS A total of 162 patients were included. The median time between LRYGB and reoperation was 17 months. At the time of reoperation, both MDs were closed in 83 patients (51.2%); thus, 79 patients (48.8%) presented at least one open MD. The group of patients with preoperative diagnosis of SBO or with recurrent abdominal pain showed significantly higher rates of open Petersen's space compared to the group of patients with other preoperative diagnoses. Preoperative body mass index (BMI) less than 40 kg/m2 at time of LRYGB was associated with a higher risk for an open MD. CONCLUSION At least one MD reopened in almost half of the patients despite routine closure during LRYGB. Therefore, the status of MDs should be routinely examined during every reoperation after LRYGB and closure of open MDs should be performed.
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12
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Feng XC, Burch M. Management of Postoperative Complications Following Bariatric and Metabolic Procedures. Surg Clin North Am 2021; 101:731-753. [PMID: 34537140 DOI: 10.1016/j.suc.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bariatric and metabolic surgery is a safe and effective treatment of morbid obesity, a disease that continues to increase in prevalence in the United States and worldwide. The two most commonly performed operations are the sleeve gastrectomy and the gastric bypass. Early and late complications can occur, and although referral to a bariatric surgeon or center is ideal, emergency management of acute problems is relevant to all general surgeons. Bariatric surgery can have surgical and metabolic consequences. An understanding of the altered anatomy and physiology helps to guide management of morbidities. This article discusses surgical postoperative complications and metabolic complications.
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Affiliation(s)
- Xiaoxi Chelsea Feng
- General Surgery, Cedars Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA 90048, USA
| | - Miguel Burch
- General Surgery, Cedars Sinai Medical Center, 8635 West 3rd Street, Suite 650W, Los Angeles, CA 90048, USA.
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Dan AG, Mellert LT. Comment on: The role of citrulline, intestinal-fatty acid binding protein and D-dimer as potential biomarkers in the diagnosis of internal herniation after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2021; 17:1712-1713. [PMID: 34301499 DOI: 10.1016/j.soard.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Adrian G Dan
- Weight Management Institute, Northeast Ohio Medical University, Summa Health System, Akron, Ohio
| | - Logan T Mellert
- Department of Surgery, Northeast Ohio Medical University, Summa Health System, Akron, Ohio
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14
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Schneider R, Schulenburg M, Kraljević M, Klasen JM, Peters T, Wölnerhanssen B, Peterli R. 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? Langenbecks Arch Surg 2021; 406:1831-1838. [PMID: 34021417 PMCID: PMC8481144 DOI: 10.1007/s00423-021-02180-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
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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Affiliation(s)
- Romano Schneider
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Michaela Schulenburg
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Thomas Peters
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital, CH-4058, Basel, Switzerland
| | | | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland.
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15
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Magouliotis DE, Tzovaras G, Tasiopoulou VS, Christodoulidis G, Zacharoulis D. Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: a Meta-Analysis. Obes Surg 2021; 30:1935-1943. [PMID: 31955371 DOI: 10.1007/s11695-020-04418-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The purpose of the current study was to review the available literature on morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to assess the clinical outcomes of the routine closure of the mesenteric defects. METHODS A literature search was performed in PubMed, Cochrane library, and Scopus, in accordance with the PRISMA guidelines. RESULTS Nine studies met the inclusion criteria. A total of 16,520 patients were incorporated with a mean follow-up ranging from 34 to 120 months. The closure of the mesenteric defects was associated with a lower incidence of internal hernias (odds ratio, 0.25 [95% confidence interval 0.20, 0.31]; p < 0.01), small bowel obstruction (SBO) (0.30 [0.17, 0.52]; p < 0.0001) and reoperations (0.28 [0.15, 0.52]; p < 0.001). Both approaches presented similar complication rates and % excess weight loss (%EWL). CONCLUSION The present meta-analysis is the best currently available evidence on the topic and supports the routine closure of the mesenteric defects.
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Affiliation(s)
- Dimitrios E Magouliotis
- Department of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | | | | | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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16
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Brammerloo YGA, Vannijvel M, Devriendt S, Verhaak T, Ultee G, Göttgens KWA, Langenhoff BS. Internal Hernia After Laparoscopic Gastric Bypass Without Preventive Closure of Mesenteric Defects: a Single Institution's Experience. J Gastrointest Surg 2021; 25:623-634. [PMID: 32767016 DOI: 10.1007/s11605-020-04761-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internal herniation (IH) is a well-known complication after laparoscopic gastric bypass (LGB). Diagnosing and managing IH can be challenging. This retrospective cohort study aimed to achieve a greater understanding of symptomatology, diagnostic tools, complications, risk of IH recurrence, and symptom relief in IH patients. METHODS We included patients who underwent LGB surgery at our institution between 2011 and 2015. Mesenteric defects were not preventively closed during LGB. We focused on LGB patients who underwent surgical intervention(s) for suspected IH during a 7-year study period. We studied patient characteristics, (predictive) symptoms and signs, abdominal imaging, operative findings, post-operative course, and risk of (recurrent) IH. RESULTS A total of 1588 patients were included. In total, 243 patients underwent IH-related diagnostic laparoscopy. Radiating pain to the back (OR 2.45, p = .03), post-prandial pain (OR 3.23, p = .00), and leukocytosis (OR 15.53, p = .01) were identified as predictors of IH. The estimated risk of IH-related diagnostic laparoscopy was 16% at 3 years post-LGB, and the risk of confirmed IH was 12%. The estimated risk of diagnostic laparoscopy for suspected recurrent IH was 10% at 5 years post-LGB. In patients who underwent secondary mesenteric defects closure, post-operative symptom relief was reported in 84%. CONCLUSION This study demonstrates a considerable risk of developing IH after LGB without preventive closure of the mesenteric defects. We emphasize the value of diagnostic laparoscopy to achieve symptom relief in patients with suspicion of IH. Preoperative diagnosis of IH can be improved by being watchful of specific symptoms and signs which can predict the intra-operative presence of IH.
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Affiliation(s)
- Y G A Brammerloo
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands.
| | - M Vannijvel
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - S Devriendt
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - T Verhaak
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - G Ultee
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - K W A Göttgens
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - B S Langenhoff
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
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17
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Pan T, Wang H, Liu K, Chen XZ, Zhang WH, Chen XL, Yang K, Zhang B, Zhou ZG, Hu JK. Closure of Petersen's defect in gastrectomy for gastric cancer: an interrupted time series analysis from a high-volume institution in China. Langenbecks Arch Surg 2020; 406:427-436. [PMID: 33151418 PMCID: PMC7936939 DOI: 10.1007/s00423-020-02019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023]
Abstract
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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Affiliation(s)
- Tao Pan
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Hui Wang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kai Liu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kun Yang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China.
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18
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Rebecchi F, Ugliono E, Palagi S, Genzone A, Toppino M, Morino M. Robotic "Double Loop" Roux-en-Y gastric bypass reduces the risk of postoperative internal hernias: a prospective observational study. Surg Endosc 2020; 35:4200-4205. [PMID: 32857240 PMCID: PMC8263431 DOI: 10.1007/s00464-020-07901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Abstract
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/m2. 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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Affiliation(s)
- Fabrizio Rebecchi
- General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Elettra Ugliono
- General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Silvia Palagi
- General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Alessandro Genzone
- General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Mauro Toppino
- General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Mario Morino
- General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A.M. Dogliotti 14, 10126, Turin, Italy.
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19
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20
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Douissard J, Gambon-Stow P, Dupuis A, Jung MK, Toso C, Hagen ME. Chronic Pain After Gastric Bypass: Another Argument to Support Mesenteric Windows Closure. Surg Laparosc Endosc Percutan Tech 2019; 30:134-136. [PMID: 31764863 DOI: 10.1097/sle.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic pain is frequent after Roux-en-Y gastric bypass (RYGB). Recurrent internal hernias (IHs) may be responsible for chronic abdominal pain. Physical examination and computed tomography are often inconclusive. This observational retrospective study describes 11 patients who underwent elective laparoscopy for post-RYGB chronic abdominal pain of undetermined etiology after noninvasive investigations and failure of conservative treatment. Open intermesenteric and/or Peterson spaces were found in all cases; IH was present in 6 cases. Nine patients were totally relieved from symptoms after mesenteric windows closure; substantial improvement was noted in the remaining 2 cases. Peterson space was found more likely to be responsible for chronic IH. In such selected patients, laparoscopic exploration and windows closure should be discussed. These findings add support to initial windows closure during RYGB.
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Affiliation(s)
- Jonathan Douissard
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
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21
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Dan AG. Comment on: Effect of the closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a prospective study. Surg Obes Relat Dis 2019; 15:1907-1909. [DOI: 10.1016/j.soard.2019.09.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
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22
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Guimarães M, Monteiro MP. Comment on: Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15:1640-1642. [PMID: 31427221 DOI: 10.1016/j.soard.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Marta Guimarães
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; Department of General Surgery, Hospital de São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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23
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Iannelli A, Sebastianelli L, Schneck AS. Internal Hernia and Roux-en-Y Gastric Bypass: Should the Routine Closure of Defects Still Be a Matter of Debate? Obes Surg 2019; 29:2614-2615. [PMID: 31165403 DOI: 10.1007/s11695-019-03846-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Antonio Iannelli
- Université Côte d'Azur, Nice, France. .,Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, 151 Route Saint Antoine de Ginestière, BP 3079, Nice CEDEX 3, France. .,Inserm, U1065, Team 8 "Hepatic Complications of Obesity", Nice, France.
| | - Lionel Sebastianelli
- Université Côte d'Azur, Nice, France.,Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, 151 Route Saint Antoine de Ginestière, BP 3079, Nice CEDEX 3, France
| | - Anne-Sophie Schneck
- Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe, France
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