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Mesenteric defect

Post-RYGB: Mesenteric defect - to close or not to close?

(Image Credit: Niels Olson)
No difference in HRQoL for mesenteric defect closure/non-closure post-RYGB

There is no difference in the health-related quality-of-life (HRQoL) outcomes in patients who received mesenteric defect closure after laparoscopic gastric bypass, compared to those patients who did not have their mesenteric defect closed, according to the results of a randomised clinical trial by researchers from Sweden.

The study, ‘Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects: a Post-hoc Analysis of Data from a Randomized Clinical Trial’, published in Obesity Surgery, assessed whether mesenteric defect closure affects health-related quality-of-life (HRQoL) after laparoscopic gastric bypass surgery.

Between May 2010 and November 2014, a total of 2,507 patients were randomised to receive a closure of the mesenteric defects (n=1,259) or non-closure (n=1,248). In the group randomised to closure of the mesenteric defects, 32 patients had neither of the mesenteric defects closed, 22 had only one mesenteric defect closed, and six were converted to open surgery after randomisation took place. For unknown reason, five patients randomised to non-closure had the defects closed with follow-up on an intention-to-treat basis. The main outcomes of the study were reoperation for small bowel obstruction and early severe postoperative complication, and HRQoL was measured and analysed as a post-hoc analysis.

At baseline, 1,931 patients (77.0%) completed their HRQoL forms, of whom 47 patients (1.9%) had not answered the SF-36 and 11 patients (0.4%) the OP questions completely. At the one-year follow-up, 1,588 patients (63.3%) completed their HRQoL forms. At the 2-year follow-up, 1,619 patients (64.6%) completed their HRQoL forms.

Two years after surgery, 78 patients (cumulative probability 6.4%) with non-closure of the mesenteric defects and 51 patients (cumulative probability 4.1%) with closed mesenteric defects had been re-operated for small bowel obstruction (p=0.013).


At 1 and 2 years after surgery, HRQoL on the OP scale had improved in both groups. Improvements in physical aspects of HRQoL and specific dimensions of mental HRQoL on the SF-36 were also observed. Patients with closed mesenteric defects experienced improvement in mental component summary at 1 and 2 years postoperatively, whereas no significant difference was seen for patients with open defects.

The researchers report that HRQoL was similar in both groups at baseline, with no significant differences reported between the two groups on the OP scale (Figure 1). In the SF-36, patients with closed mesenteric defects reported slightly better HRQoLs with regard to social functioning (ES=0.1) and role emotional at the two-year follow-up (ES=0.1).

Figure 1: Obesity problems score for the two study groups at baseline, 1 and 2 years after the operation

In addition, they report that irrespective of closure of the mesenteric defects or not, patients re-operated for small bowel obstruction reported lower HRQoL for some aspects of physical and mental HRQoL, when compared with patients not experiencing this complication.

At the two-year follow-up, differences were seen on the SF-36 regarding physical role (74 ± 41.4 vs. 86 ± 30.5, p=0.013, ES=0.3), general health (71±23.1 vs. 77±22.2, p=0.019, ES=0.3), vitality (54±26.1 vs. 64±25.3, p=0.001, ES=0.4), and social functioning (79 ± 28.3 vs. 86 ± 22.9, p = 0.046, ES = 0.3). No significant difference was seen on the OP scale (small bowel obstruction 21±24.3 vs. no-SBO 23±23.3, p=0.398).

When patients re-operated for small bowel obstruction were excluded from the analysis, no difference in HRQoL was seen on the OP scale between patients with or without closure of the mesenteric defects (open defects 22±24.9 vs. closed defects 20±23.8, p=0.093).

On the SF-36, patients randomised to mesenteric defect closure still reported slightly higher scores for social functioning (open defects 85±24.2 vs. closed defects 87±22.1, p=0.041, ES=0.1) and role emotional (open defects 82±35.0 vs. closed defects 85±31.5, p=0.031, ES=0.1).

Patients who failed to report on HRQoL at 2 years were younger (40.1±10.28 years vs. 42.7±10.88, p<0.0001), had a higher preoperative BMI (42.8±5.37, vs. 42.1±4.84, p=0.001), and were more often active or previous smokers (35.9% vs. 30.3%, p=0.008), but there were fewer with sleep apnoea (6.1% vs. 9.5%, p=0.003), hypertension (22.5% vs. 28.4%, p=0.001) and dyslipidaemia (9.8% vs. 12.5%, p=0.045).

“To our knowledge, the present study is the first to compare HRQoL in patients after laparoscopic gastric bypass surgery with or without mesenteric defect closure. Despite a slightly better improvement in some aspects of HRQoL, our results indicate that mesenteric defect closure during the primary operation does not affect HRQoL after surgery,” the authors write. “In conclusion, the results of this study do not invalidate previous recommendation that the mesenteric defects should be routinely closed during laparoscopic gastric bypass procedures.”

To access this paper, please click here

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