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Closure of mesenter...
Closure of mesenteric defects in laparoscopic gastric bypass : a multicentre, randomised, parallel, open-label trial
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- Stenberg, Erik, 1979- (author)
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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- Szabo, Eva, 1973- (author)
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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- Ågren, Göran (author)
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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- Ottosson, Johan (author)
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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- Marsk, Richard (author)
- Karolinska Institutet
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- Lönroth, Hans, 1952 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för gastrokirurgisk forskning och utbildning,Institute of Clinical Sciences, Department of Gastrosurgical Research and Education
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- Boman, Lars (author)
- Department of Surgery, Lycksele Hospital, Lycksele, Sweden
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- Magnuson, Anders (author)
- Clinical Epidemiology and Biostatistics
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- Thorell, Anders (author)
- Karolinska Institutet
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- Näslund, Ingmar (author)
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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(creator_code:org_t)
- Elsevier, 2016
- 2016
- English.
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In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 387:10026, s. 1397-1404
- Related links:
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https://urn.kb.se/re...
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Abstract
Subject headings
Close
- Background: Small bowel obstruction due to internal hernia is a common and potentially serious complication after laparoscopic gastric bypass surgery. Whether closure of surgically created mesenteric defects might reduce the incidence is unknown, so we did a large randomised trial to investigate.Method: This study was a multicentre, randomised trial with a two-arm, parallel design done at 12 centres for bariatric surgery in Sweden. Patients planned for laparoscopic gastric bypass surgery at any of the participating centres were off ered inclusion. During the operation, a concealed envelope was opened and the patient was randomly assigned to either closure of mesenteric defects beneath the jejunojejunostomy and at Petersen's space or non-closure. After surgery, assignment was open label. The main outcomes were reoperation for small bowel obstruction and severe postoperative complications. Outcome data and safety were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials. gov, number NCT01137201.Findings: Between May 1, 2010, and Nov 14, 2011, 2507 patients were recruited to the study and randomly assigned to closure of the mesenteric defects (n= 1259) or non-closure (n= 1248). 2503 (99.8%) patients had follow-up for severe postoperative complications at day 30 and 2482 (99.0%) patients had follow-up for reoperation due to small bowel obstruction at 25 months. At 3 years after surgery, the cumulative incidence of reoperation because of small bowel obstruction was signifi cantly reduced in the closure group (cumulative probability 0.055 for closure vs 0.102 for non-closure, hazard ratio 0.56, 95% CI 0.41-0.76, p= 0.0002). Closure of mesenteric defects increased the risk for severe postoperative complications (54 [4.3%] for closure vs 35 [2.8%] for non-closure, odds ratio 1.55, 95% CI 1.01-2.39, p= 0.044), mainly because of kinking of the jejunojejunostomy.Interpretation: The results of our study support the routine closure of the mesenteric defects in laparoscopic gastric bypass surgery. However, closure of the mesenteric defects might be associated with increased risk of early small bowel obstruction caused by kinking of the jejunojejunostomy.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Allmänmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- General Practice (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Keyword
- Family Medicine
- Allmänmedicin
Publication and Content Type
- ref (subject category)
- art (subject category)
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The Lancet
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- By the author/editor
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Stenberg, Erik, ...
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Szabo, Eva, 1973 ...
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Ågren, Göran
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Ottosson, Johan
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Marsk, Richard
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Lönroth, Hans, 1 ...
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show more...
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Boman, Lars
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Magnuson, Anders
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Thorell, Anders
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Näslund, Ingmar
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and General Practice
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Gastroenterology ...
- Articles in the publication
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The Lancet
- By the university
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Örebro University
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Karolinska Institutet
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University of Gothenburg