Closure of mesenteric defects is associated with a higher incidence of small bowel obstruction due to adhesions after laparoscopic antecolic Roux-en-y gastric bypass: A retrospective cohort study. (November 2019)

• Record Type: Journal Article
• Authors: Nuytens, Frederiek; D'Hondt, Mathieu; Van Rooy, Frank; Vansteenkiste, Franky; Pottel, Hans; Abasbassi, Mohammed; Servaege, Ann; Devriendt, Dirk
• Is Part Of: International journal of surgery. Volume 71(2019)
• Page Start: 149
• Page End: 155
• Publication Date: 2019-11
• Subjects: Roux-en-y gastric bypass -- Internal herniation -- Adhesions -- Small bowel obstruction -- Smoking; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2019.09.017
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: Small bowel obstruction (SBO) is a frequent complication after laparoscopic Roux-en-y gastric bypass (LRYGB). Objectives: We wanted to evaluate the effect of closure of the mesenteric defects on the incidence of SBO and postoperative complications after LRYGB. Furthermore, we wanted to identify possible risk factors for SBO. Methods: This study was a retrospective cohort study of 1364 patients who underwent a LRYGB between July 2003 and October 2015. Cohort 1 contained 724 patients in whom mesenteric defects were not closed. Cohort 2 contained 640 patients in whom mesenteric defects were closed. Main outcome parameters were the incidence of SBO and postoperative complications as well as potential risk factors for SBO. Results: Closure of the mesenteric defects was associated with a reduction in the incidence of SBO due to internal herniation (4.8% vs. 5.5, p = 0.02) but resulted in a higher incidence of SBO due to postoperative adhesions (4.8% vs. 1.7%, p = 0.004). Multivariate analysis identified smoking as a risk factor for SBO (p = 0.0187). We observed a higher incidence of late postoperative pain in cohort 2 (5.3% vs. 2.1%, p = 0.007). Conclusion: Although closure of the mesenteric defects is associated with a lower incidence of SBO due to internal herniation, this effect is countered by a higher incidence of SBO due to postoperative adhesions. Smoking is an independent risk factor for SBO after LRYGB. Closure of the mesenteric defects is associated with a higher incidence of late postoperative pain. Highlights: Small bowel obstruction is a frequent complication after laparoscopic Roux-en-y gastric bypass. Retrospective cohort study of 1364 patients with or without closure of mesenteric defects. Closure was associated with a reduction of internal herniation. Closure resulted in a higher incidence of SBO due to adhesions. More late postoperative pain if mesenteric defects were closed.