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Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery: a Register-Based Cohort Study
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.ORCID iD: 0000-0003-4958-1611
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
2019 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 4, p. 1229-1235Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Routine closure of mesenteric defects is generally considered standard part of laparoscopic gastric bypass surgery today. Controversy still exists regarding the optimal method for mesenteric defects closure. The objective was to compare different methods for mesenteric defects handling in laparoscopic gastric bypass surgery.

METHODS: Primary laparoscopic gastric bypass procedures from 2010 until 2015 reported to the Scandinavian Obesity Surgery Registry (SOReg), where the mesenteric defects closure method was identifiable, were included. Main outcome measures were serious postoperative complication within 30 days after surgery, and reoperation for small bowel obstruction within 5 years after surgery. Quality-of-life before and after surgery, duration of surgery, and risk factors for complication were also analyzed. Information on operation for small bowel obstruction was based on data from the SOReg, the Swedish National Patient Register and reviews of hospital charts.

RESULTS: In all, 34,707 patients were included. Serious postoperative complication occurred in 174 (2.9%) patients with sutures, in 592 (3.1%, adjusted p = 0.079) with clips, and 278 (3.1%; adjusted p = 0.658) in the non-closure group. Reoperation for small bowel obstruction within 5 years after surgery was lower with sutures (cumulative incidence 6.9%) and clips (cumulative incidence 7.3%; adjusted HR 1.16, 95% CI 1.02-1.32, p = 0.026), compared to non-closure (cumulative incidence 11.2%; adjusted HR 1.63, 95% CI 1.44-1.84, p < 0.0001).

CONCLUSION: Closure of the mesenteric defects using either non-absorbable metal clips or non-absorbable running sutures is a safe and effective measure to reduce the risk for small bowel obstruction after laparoscopic gastric bypass surgery. Sutures appear slightly more effective and should remain gold standard for mesenteric defects closure.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2019. Vol. 29, no 4, p. 1229-1235
Keywords [en]
Bariatric surgery, Gastric bypass, Internal hernia, Postoperative complication, Prevention, Small bowel obstruction
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-71852DOI: 10.1007/s11695-018-03670-xISI: 000467148300022PubMedID: 30675687Scopus ID: 2-s2.0-85060594258OAI: oai:DiVA.org:oru-71852DiVA, id: diva2:1288102
Note

Funding Agencies:

Örebro Region County Council  

Örebro University 

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-18Bibliographically approved

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Stenberg, ErikOttosson, JohanSzabo, Eva

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