Closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis

Abstract

Background

The comparative evidence regarding the outcomes of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass (LRYGB) is poorly understood. We aimed to compare the outcomes of closure versus non-closure of mesenteric defects in LRYGB for morbid obesity.

Methods

We conducted a search of electronic information sources to identify all comparative studies investigating the outcomes of closure versus non-closure of mesenteric defects in patients undergoing LRYGB for morbid obesity. We used the Cochrane risk of bias tool and the ROBINS-I tool to assess the risk of bias of RCTs and observational studies, respectively. Random or fixed effects modelling was applied as appropriate.

Results

We included 10,031 patients from six observational studies and 2609 patients from two RCTs. Analysis of observational studies showed closure defects resulted in lower risks of internal hernia (OR 0.28, 95% CI 0.15, 0.54) and reoperation for small bowel obstruction (SBO) (OR 0.30, 95% CI 0.10, 0.83); no difference was found between the two groups in terms of SBO not related to internal hernia (OR 1.19, 95% CI 0.47, 2.99), early SBO (OR 0.74, 95% CI 0.04, 14.38), anastomotic leak (OR 0.84, 95% CI 0.45, 1.57), bleeding (OR 1.08, 95% CI 0.62, 1.89), and anastomotic ulcer (OR 2.08, 95% CI 0.62, 6.94). Analysis of RCTs showed closure of defects resulted in lower risks of internal hernia (OR 0.29, 95% CI 0.19,0.45) and reoperation for SBO (OR 0.51, 95% CI 0.38, 0.69) but higher risks of SBO not related to internal hernia (OR 1.90, 95% CI 1.09, 3.34) and early SBO (OR 2.63, 95% CI 1.16, 5.96); no difference was found between the two groups in terms of anastomotic leak (OR 1.95, 95% CI 0.80, 4.72), bleeding (OR 0.67, 95% CI 0.38, 1.17), and anastomotic ulcer (OR 2.08, 95% CI 0.62, 6.94).

Conclusions

Our results suggest that closure of mesenteric defects in LRYGB may be associated with lower risks of internal herniation and reoperation for SBO compared with non-closure of the defects (moderate certainty). The available evidence is inconclusive regarding the risks of SBO not related to internal hernia and early SBO (low certainty). More RCTs are needed to improve the robustness of the available evidence.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors

Contributions

RM and SH contributed to conception and design. MA, AS, KAK, MMM, and SH helped with data collection. SH and SH contributed to analysis and interpretation. SH, SH, and RM involved in writing the article. All authors contributed to critical revision of the article and final approval of the article. SH and SH helped with statistical analysis.

Corresponding author

Correspondence to Shahab Hajibandeh.

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Disclosure

Shahab Hajibandeh, Shahin Hajibandeh, Mostafa Abdelkarim, Ahmad Shehadeh, Muhammad Mahid Mohsin, Khursheed Ahmed Khan and Richard Morgan have no conflicts of interest or financial ties to disclose.

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Appendix

Appendix

Search no. Search strategy
#1 MeSH descriptor: [bypass, roux en y gastric] explode all trees
#2 MeSH descriptor: [ anastomosis, roux en y] explode all trees
#3 Roux en y near2 bypass: TI,AB,KW
#4 Roux-en-y near2 bypass: TI,AB,KW
#5 #1 OR #2 OR #3 OR #4
#6 Mesenteric defect: TI,AB,KW
#7 Petersen's defect: TI,AB,KW
#8 Jejunojejunal defect: TI,AB,KW
#9 #6 OR #7 OR #8
#10 #5 AND #9
  1. This search strategy was adopted for following databases: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL)

Combination of key words to be used in databases:

((("gastric bypass"[MeSH Terms] OR "anastomosis, roux-en-y"[MeSH Terms]) OR ("anastomosis, roux-en-y"[MeSH Terms] OR ("anastomosis"[All Fields] AND "roux-en-y"[All Fields]) OR "roux-en-y anastomosis"[All Fields] OR "roux en y bypass"[All Fields])) OR ("anastomosis, roux-en-y"[MeSH Terms] OR ("anastomosis"[All Fields] AND "roux-en-y"[All Fields]) OR "roux-en-y anastomosis"[All Fields] OR "roux en y bypass"[All Fields])) AND ((((("mesentery"[MeSH Terms] OR "mesentery"[All Fields] OR "mesenteric"[All Fields]) AND defect[All Fields]) OR (petersen's[All Fields] AND defect[All Fields])) OR (jejunojejunal[All Fields] AND defect[All Fields])) OR defect[All Fields]).

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Hajibandeh, S., Hajibandeh, S., Abdelkarim, M. et al. Closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Endosc 34, 3306–3320 (2020). https://doi.org/10.1007/s00464-020-07544-1

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Keywords

  • Laparoscopy
  • Roux-en-Y gastric bypass
  • Mesenteric defect
  • Internal hernia