I read with interest the article entitled “The Effect of Routine Division of the Greater Omentum on Small Bowel Obstruction After Roux-en-Y Gastric Bypass” [
]. The article discusses the role of routine division of the greater omentum during laparoscopic Roux-en-Y gastric bypass (LRYGB) to reduce small bowel obstruction (SBO). We know that preventable SBO comes from closing mesenteric defects, and from a cohort of 40,517 patients operated with LRYGB in Sweden for 8 years, and with a follow-up of nearly 6 years, the cumulative incidence of SBO was 11.2% in the nondivision group compared with 9.7% among patients with divided omentum (hazard ratio = .83, P < .001). This was seen in patients without mesenteric defects closure as well as patients with closed mesenteric defects. Schneider et al. [
- Josefsson E.
- Ottosson J.
- Näslund I.
- Näslund E.
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: 178-183
] have observed a low rate of Petersen defect mesenteric hernia when the omentum is divided in a T-shape. When the jejunal mesenteric space is closed, internal hernias were reduced from 5.3% to 2.4%.
- Schneider R.
- Schulenburg M.
- Kraljević M.
- et al.
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
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- 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: 178-183
- 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
- Symptomatic internal hernias after laparoscopic bariatric surgery.Surg Endosc. 2005; 19: 34-39
- Laparoscopic gastric bypass. Another option in bariatric surgery.Surg Endosc. 1996; 10: 636-638
- Laparoscopic gastric bypass.Obes Surg. 1998; 8: 563-565
- 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
Published online: February 11, 2023
Publication stageIn Press Journal Pre-Proof
© 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