96 - Freie Mitteilung
3. Juni 2022, 12:15 - 13:45, Panorama 1


Efficacy of primary complete closure of the mesenteric defects during gastric bypass
I. Lazaridis1, M. Kraljevic1, T. Köstler2, L. Kübler1, U. Zingg2, T. Delko1, Presenter: I. Lazaridis1 (1Basel, 2Zurich- Schlieren)

Internal hernias (IH) are a common complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). The closure of the mesenteric defect (MD) is widely accepted as a measure to prevent IH. However, long-term efficacy of initial MD closure is unknown. The aim of this study is to investigate the risk of reopening of the intermesenteric and Petersen space after closure with non- absorbable suture during index RYGB. The secondary objective was to determine any risk factors associated with the reopening of the MD.
This is a retrospective analysis of all re-operations following primary LRYGB with complete closure of MD performed between 2010 and 2018. Data of all consecutive patients who underwent elective or emergency re-operations after proximal LRYGB was reviewed.
A total of 207 patients underwent a reoperation during the study period. The status of the MD was recorded in 162 patients, who were therefore included in the study. The median time between LRYGB and re-operation was 17 months (IQR 10.0 -30.5). The indications for the re-operations were as follows: gallstone disease (n= 48, 29.6%), recurrent abdominal pain (73, 45.1%), weight regain or insufficient weight loss (n=21, 13.0%), small bowel obstruction (n=14, 8.6%), symptomatic hernia (n=4, 2.5%), marginal ulcer (n=1, 0.6%), pouch fistula (n=1, 0.6%). At the time of re-operation, 35 patients (21.6%) and 28 patients (17.3%) had a partially open and totally open Petersen space, respectively. A partially open and a totally open intermesenteric defect was found in 33 patients (20.4%) and 4 patients (2.5%), respectively. Both MD were closed in 83 patients (51.2%), thus 79 patients (48.8%) presented at least one open MD. Preoperative BMI less than 40 kg/m2 at the time of LRYGB was associated with a higher risk of developing an open mesenteric defect at the time of reoperation (33 patients [41.8%] at the group of patients with at least one open MD vs 22 patients [26.5%] at the group of patients presenting both MD closed, OR 1.99, 95% CI 1.02- 3.81; P=0.047).
Primary closure of Petersen`s space and intermesenteric defect during LRYGB reduces by half the risk of an open MD. Since reopening of MD can still occur in almost half of the patients, a careful observation of the state of both MD during re-operation, regardless of their indication, is strongly recommended.
Für statistische Zwecke und um bestmögliche Funktionalität zu bieten, speichert diese Website Cookies auf Ihrem Gerät. Das Speichern von Cookies kann in den Browser-Einstellungen deaktiviert werden. Wenn Sie die Website weiter nutzen, stimmen Sie der Verwendung von Cookies zu.