Mesenteric defect closure in Roux-en-Y reduces 10-year risk for small bowel obstruction
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Key takeaways:
- Closure of mesenteric defects during gastric bypass reduced the 10-year incidence of reoperation for small bowel obstruction from 14.9% to 7.8%.
- Researchers suggest routine use of this procedure.
Closure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass reduced the long-term risk for small bowel obstruction, according to study results in JAMA Surgery.
“One of the most serious complications of [laparoscopic Roux-en-Y gastric bypass] has been internal herniation resulting in small bowel obstruction,” Erik Stenberg, MD, of the department of surgery at Örebro University in Sweden, and colleagues wrote. “Studies reporting long-term follow-up suggest a high incidence (10%-20%) of internal herniation and small bowel obstruction if no measures are taken to reduce the incidence.
“Closure of mesenteric defects has been reported to reduce the risk of small bowel obstruction. However, due to technical difficulties with this intervention, mesenteric defects may be insufficiently closed or may even open with time due to reduction of the amount of adipose tissue.”
In a randomized clinical trial, Stenberg and colleagues assessed the long-term safety and efficacy of mesenteric defect closure among 2,507 patients with severe obesity (mean age, 41.7 years; 74.3% women) who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) from May 2010 to November 2011.
Participants were assigned to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB (n = 1,259) or non-closure (n = 1,248). The primary outcome was reoperation for small bowel obstruction 3 years after surgery, while secondary outcomes included new chronic opioid use and reoperation for internal hernia.
Researchers followed-up with 94.8% of patients in the closure group and 96% of patients in the non-closure group over a median of 10 years. The cumulative incidence of reoperation for small bowel obstruction was 7.8% (95% CI, 6.4-9.4) and 14.9% (95% CI, 13-16.9), respectively.
Researchers also reported new incident chronic opioid use among 175 of 863 opioid-naïve patients who did not undergo closure, which corresponded to a 10-year cumulative incidence of 20.4% (95% CI, 17.7-23). In contrast, 166 of 895 opioid-naïve patients who underwent closure were considered chronic new incident users, which corresponded to a 10-year cumulative incidence of 18.7% (95% CI, 16.2-21.3).
“In this open-label, registry-based randomized controlled trial in Sweden, closure of the mesenteric defects in LRYGB reduced the risk of small bowel obstruction up to 10 years after surgery,” Stenberg and colleagues concluded. “The findings suggest that routine use of this procedure in LRYGB operations should be considered.”
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