Internal Hernia After Gastric Bypass: A New and Simplified Technique for Laparoscopic Primary Closure of the Mesenteric Defects
| Autor: | H. J. Jacobsen, Jan Hedenbro, Björn Geir Leifson, Bent Johnny Nergaard, Ebrahim Aghajani, H. Gislason |
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| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Internal hernia
Mesenteric defects Adult Male Reoperation medicine.medical_specialty Time Factors Adolescent education Gastric bypass Gastric Bypass Young Adult Postoperative Complications medicine Humans Hernia Mesentery Laparoscopy Herniorrhaphy LRGB Aged Retrospective Studies medicine.diagnostic_test business.industry General surgery Suture Techniques Gastroenterology Middle Aged medicine.disease digestive system diseases Surgery Hernia Abdominal Obesity Morbid Bowel obstruction stomatognathic diseases surgical procedures operative medicine.anatomical_structure Treatment Outcome Female How I do it Complication business Abdominal surgery Follow-Up Studies |
| Zdroj: | Journal of Gastrointestinal Surgery |
| ISSN: | 1873-4626 1091-255X |
| Popis: | Background Bowel obstruction due to internal hernia is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRGB). Increasing evidence supports primary closing of the mesenteric defects, but controversy continues about surgical technique of systematic closure. This paper reviews our experience with internal hernia after LRGB and describes a new method of preemptive closure of the mesenteric defects. Material and Methods Two thousand four hundred seventy-two consecutive patients undergoing LRGB from September 2005 to June 2010 were entered into our prospective longitudinal database. The mesenteric defects were not closed. Patients entered a 5-year follow-up program, and all who subsequently presented with internal hernia were analyzed. A further 1,630 patients operated on in the last 12 months were subjected to our new technique of closing the defects; data were entered in our own database as well as in the Scandinavian quality registry. Follow-up time for these patients is limited. Results In the first group, 117 patients developed an internal hernia (4.7%) at a mean interval after LRGB of 13 (range, 4–43 months). Four patients needed bowel resections because of severe ischemia. There was one death associated with complication of the internal hernia. In the primary closure group, four patients early in the series had reoperations for kinking of the enteroanastomosis. There have been no mesenteric haematomas encountered. Conclusions Internal hernia should be ruled out in patients with previous LRGB and abdominal pain. Our technique for primary closing of the mesenteric defects seems to be safe and is so far promising. |
| Databáze: | OpenAIRE |
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