Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass

Background: Although most surgeons believe that internal hernia (IH) defects should be closed. no general consensus has yet been reached. The published studies have reported conflicting obstruction incidence estimates and variations in location. Some have also argued that closed hernia sites recur. Methods: A retrospective review of 2079 Roux-en-Y gastric bypass procedures performed by 1 surgeon from 2001 to 2009 was conducted. Chi-square analysis compared those performed from 2001 to August 2003 (group I) with those from September 2003 to 2009 (group 2) for the incidence of IH. Since September 2003, the jejunojejunal anastomotie mesenteric defect has been closed with a running. permanent suture. In contrast, before September 2003. the defect was not closed. Results: A total of 37 patterns presented with symptomatic IH from 2001 to 2009. A significant difference was found in the proportion of those patients who experienced IH in group 1 (n = 36) compared with those who did so in group 2 (n = P < .001). Group I developed 35 IHs (10%) at the jejunojejunal anastomotic mesenteric defect and 6 (1.7%) at Petersen's defect. The median interval to presentation was 20 months (range 5-34). Of the 35 patients. 5 (1.4%) presented acutely with pain or bowel obstruction. Group 2 developed no at the mesenteric defect (0%) and I at Petersen's defect (.1%). The interval to presentation was 9 months. Conclusion: The incidence of III after laparoscopic Roux-en-Y gastric bypass can he reduced with closure of mesenteric defects. IHs can present either acutely with pain and obstructive symptoms or chronically with vague, intermittent postprandial pain. (Surg Obes Relat Dis 2011; 7:176-180.) (C) 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.