Taselaar Annick E, de Bruin Ron W F, Kuijper T Martijn, van der Harst Erwin, Klaassen René A
Maasstad Ziekenhuis, Rotterdam, Netherlands.
Erasmus MC, Rotterdam, Netherlands.
Obes Surg. 2025 Jul 10. doi: 10.1007/s11695-025-07969-4.
The rising obesity rates have led to an increased demand for bariatric surgery, particularly laparoscopic Roux-en-Y gastric bypass (LRYGB). While effective, LRYGB carries risks such as internal herniation (IH). This study evaluates the impact of routinely closing mesenteric defects (MD) during LRYGB on IH incidence and postoperative outcomes in a high-volume bariatric center.
We conducted a retrospective cohort study of 6896 and 1903 LRYGB procedures before and after implementing routine MD closure respectively. We analyzed incidence of IH, kinking at the jejunojejunostomy (JJ), ICU admissions, hospital stay, postoperative pain relief, and the diagnostic value of CT scans.
The incidence of IH in the closure group (2.84%) was not significantly different from the non-closure group (2.80%). Postoperative pain relief rates were similar between the groups. However, routine MD closure led to the occurrence of JJ kinking (0.84%), which was not present in the non-closure group, resulting in prolonged hospital stays and ICU admissions. CT scans were predictive for IH but had limitations.
Routine closure of MD during LRYGB did not reduce IH incidence but introduced the new complication of JJ kinking. Postoperative pain relief rates were unaffected by MD closure. Our findings highlight the need for further research on alternative closure methods and improved diagnostic strategies to optimize surgical outcomes.
肥胖率的不断上升导致对减肥手术的需求增加，尤其是腹腔镜Roux-en-Y胃旁路术（LRYGB）。虽然LRYGB有效，但它存在诸如内疝（IH）等风险。本研究评估了在大容量减肥中心进行LRYGB手术时常规闭合肠系膜缺损（MD）对IH发生率和术后结局的影响。
我们分别对实施常规MD闭合前后的6896例和1903例LRYGB手术进行了回顾性队列研究。我们分析了IH的发生率、空肠吻合口（JJ）扭结、入住重症监护病房（ICU）情况、住院时间、术后疼痛缓解情况以及CT扫描的诊断价值。
闭合组的IH发生率（2.84%）与未闭合组（2.80%）无显著差异。两组术后疼痛缓解率相似。然而，常规MD闭合导致JJ扭结的发生（0.84%），未闭合组未出现这种情况，导致住院时间延长和入住ICU。CT扫描对IH有预测作用，但存在局限性。
LRYGB手术中常规闭合MD并未降低IH发生率，但引入了JJ扭结这一新的并发症。MD闭合对术后疼痛缓解率无影响。我们的研究结果凸显了对替代闭合方法和改进诊断策略进行进一步研究以优化手术结局的必要性。
