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Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis

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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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Authors and Affiliations

  1. Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey, UK

    Duncan Muir, Byung Choi, Caterina Clements, Kumaran Ratnasingham, Shashi Irukulla & Samer Humadi

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  1. Duncan Muir
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  2. Byung Choi
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  3. Caterina Clements
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Correspondence to Duncan Muir.

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Ethics Approval

Utilisation of the NHS Research Ethics Committee tool provided by the Medical Research Council determined that ethical approval was not required for this study as this was a meta-analysis and systematic review of published research.

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Key Points

• Closure of mesenteric defects is associated with lower internal hernia rates post LRGB.

• No significant difference in internal hernia rates between sutures or staples for defect closure.

• Closure of mesenteric defects resulted in fewer reoperations for suspected small bowel obstruction post LRGB.

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Muir, D., Choi, B., Clements, C. et al. Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis. OBES SURG 33, 2229–2236 (2023). https://doi.org/10.1007/s11695-023-06597-0

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