Abstract
Background
It is common practice to close mesenteric defects in abdominal surgery to prevent
postoperative herniation and subsequent closed-loop obstruction. The aim of this study
was to review our experience with antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGBP) without division of the small bowel mesentery or closure
of potential mesenteric defects.
Methods
Data for 1400 patients who underwent AA-LRYGBP between January 2001 and December 2004
was prospectively collected and retrospectively analyzed for the incidence of internal
hernias. In all cases, an antecolic antegastric approach was performed without division
of the small bowel mesentery or closure of potential hernia defects.
Results
Three patients (0.2%) developed a symptomatic internal hernia. Two of these patients
had a 200-cm-long Roux limb, and the other had a 100-cm-long Roux limb. All three
patients exhibited mild symptoms of partial small bowel obstruction. In all three
cases the internal hernia was clinically manifested more than 10 months after the
original AA- LRYGBP. Exploration revealed that the hernia site was between the transverse
colon and the mesentery of the alimentary limb at the level of the jejunojejunostomy
(Petersen’s defect) in all three cases. All three patients underwent successful laparoscopic
revision, hernia reduction, and mesenteric defect closure.
Conclusions
AA-LRYGBP without division of the small bowel mesentery or closure of mesenteric defects
does not result in an increased incidence of internal hernias. The laparoscopic approach
for reexploration appears to be an effective and safe option.
Keywords
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Article info
Publication history
Published online: March 07, 2006
Accepted:
November 17,
2005
Received in revised form:
November 16,
2005
Received:
April 13,
2005
Identification
Copyright
© 2006 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
