Roux-en-Y gastric bypass (RYGB) is an effective treatment for obesity with low complication rates. The risks of anastomotic leak, marginal ulcer, and small bowel obstruction (SBO) mainly due to internal hernia remain a challenge. There are techniques to mitigate these risks, including utilizing an antecolic antegastric approach and closure of the mesenteric defects. These technical steps have been shown to reduce the risk of internal hernias both in retrospective studies and randomized controlled trials [
- Magouliotis D.E.
- Tzovaras G.
- Tasiopoulou V.S.
- Christodoulidis G.
- Zacharoulis D.
Closure of mesenteric defects in laparoscopic gastric bypass: a meta-analysis.
Obes Surg. 2020; 30: 1935-1943
]. The authors of this article certainly subscribe to this dictum and have previously contributed to our understanding of the importance of mesenteric closures.
- Stenberg E.
- Szabo E.
- Ågren G.
- et al.
Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial.
Lancet. 2016; 387: 1397-1404
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- Closure of mesenteric defects in laparoscopic gastric bypass: a meta-analysis.Obes Surg. 2020; 30: 1935-1943
- Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial.Lancet. 2016; 387: 1397-1404
- The effect of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2023; 19: 178-186
- 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
- Omental torsion after laparoscopic Roux-en-Y gastric bypass mimicking appendicitis: a case report and review of the literature.Case Rep Surg. 2016; 20167985795
Published online: October 10, 2022
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- The effect of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypassSurgery for Obesity and Related DiseasesVol. 19Issue 3Open Access
- Comment on: The impact of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypassSurgery for Obesity and Related DiseasesVol. 19Issue 3
- PreviewRoux-en-Y gastric bypass (RYGB) is the only bariatric surgery (BS) operation that can be said to have withstood the test of time. It was developed in 1977 by Griffen et al . elaborating on the bypass proposed by Mason ; 45 years later, it is still stably the second most performed operation worldwide, representing around 30% of BS procedures (according to the latest International Federation for the Surgery of Obesity and Metabolic Disorders [IFSO] survey), and remains the procedure of choice for patients with concomitant severe gastroesophageal reflux or Barrett esophagus .