Establishing Methods of Defect Closure in Roux-en-Y Gastric Bypass: an International Survey

Abstract

Introduction: Internal herniation (IH) can be a life-threatening complication of Roux-en-Y gastric bypass (RYGB). Randomised controlled trials support the routine closure of mesenteric spaces at RYGB. However, there is currently no consensus on the method of closure in clinical practice. The purpose of this survey is to understand bariatric surgeons' practice in this regard.

Methods: We conducted an international survey, whereby questions were created through collaboration of a consensus group of bariatric surgeons and hosted on the SurveyMonkey platform. The survey was distributed among British Obesity and Metabolic Surgery Society (BOMSS) members and international professional channels including The Upper Gastrointestinal Society (TUGS) and social media.

Results: One hundred and thirty-six surgeons from 34 countries completed the survey. Of these, 49 respondents were UK-based surgeons with a cumulative experience of approximately 2500 RYGB per annum. Forty-five (91.8%) respondents reported always closing mesenteric defects, of whom 57.8% elected to use non-absorbable non-barbed sutures, followed by staples/clips in 28.9% and a selection of other methods. Most respondents used more than one method. A total of 2 UK and 14 non-UK participants reported never closing mesenteric spaces.

Conclusions: This survey has shown heterogeneity among defect closure and no consensus on preferred type. Additionally, there remains a practice of non-closure of mesenteric defects. We hope these findings help to inform further needed research and consensus building among experts.

Keywords: Absorbable suture; Antegastric antecolic; Antegastric retrocolic; Bariatric surgery; Consensus; Defect; Delayed closure; Endohernia; Internal hernia; Jejunojejunostomy; Laparoscopic gastric bypass; Mesenteric; Mesocolic; Metabolic surgery; Non-absorbable suture; Non-closure; Petersen’s; Qualitative; Retrogastric antecolic; Retrogastric retrocolic; Roux-en-Y; Survey; Weight loss.