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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005347naa a2200421 4500
001oai:DiVA.org:oru-105910
003SwePub
008230511s2023 | |||||||||||000 ||eng|
009oai:prod.swepub.kib.ki.se:152677380
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-1059102 URI
0247 a https://doi.org/10.1001/jamasurg.2023.10422 DOI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1526773802 URI
040 a (SwePub)orud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Stenberg, Erik,d 1979-u Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Hand and Orthopedic Surgery4 aut0 (Swepub:oru)eisg
2451 0a Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery :b A Randomized Clinical Trial
264 1b American Medical Association (AMA),c 2023
338 a print2 rdacarrier
500 a Funding agencies:Bengt Ihre FoundationErling-Persson Foundation
520 a IMPORTANCE: Short-term and midterm data suggest that mesenteric defects closure during laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery reduces the risk of internal herniation with small bowel obstruction (SBO) but may increase risk of kinking of the jejunojejunostomy in the early postoperative period. However, to our knowledge, there are no clinical trials reporting long-term results from this intervention in terms of risk for SBO or opioid use.OBJECTIVE: To evaluate long-term safety and efficacy outcomes of closure of mesenteric defects during LRYGB.DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial with a 2-arm, parallel, open-label design included patients with severe obesity scheduled for LRYGB bariatric surgery at 12 centers in Sweden from May 1, 2010, through November 14, 2011, with 10 years of follow-up after the intervention. INTERVENTIONS: During the operation, patients were randomly assigned 1:1 to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB or to nonclosure.MAIN OUTCOME AND MEASURES: The primary outcome was reoperation for SBO. New incident, chronic opioid use was a secondary end point as a measure of harm.RESULTS: A total of 2507 patients (mean [SD] age, 41.7 [10.7] years; 1863 female [74.3%]) were randomly assigned to closure of mesenteric defects (n = 1259) or nonclosure (n = 1248). After censoring for death and emigration, 1193 patients in the closure group (94.8%) and 1198 in the nonclosure group (96.0%) were followed up until the study closed. Over a median follow-up of 10 years (IQR, 10.0-10.0 years), a reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure (10-year cumulative incidence, 14.9%; 95% CI, 13.0%-16.9%) and in 98 patients with closure (10-year cumulative incidence, 7.8%; 95% CI, 6.4%-9.4%) (subhazard ratio [SHR], 0.42; 95% CI, 0.32-0.55). New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure (10-year cumulative incidence, 20.4%; 95% CI, 17.7%-23.0%) and 166 of 895 opioid-naive patients with closure (10-year cumulative incidence, 18.7%; 95% CI, 16.2%-21.3%) (SHR, 0.90; 95% CI, 0.73-1.11).CONCLUSIONS AND RELEVANCE: This randomized clinical trial found long-term reduced risk of SBO after mesenteric defects closure in LRYGB. The findings suggest that routine use of this procedure during LRYGB should be considered.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01137201.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
7001 a Ottosson, Johan,d 1957-u Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Surgery4 aut0 (Swepub:oru)jhon
7001 a Magnuson, Andersu Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden4 aut
7001 a Szabo, Eva,c PhD,d 1973-u Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Surgery4 aut0 (Swepub:oru)eso
7001 a Wallén, Stefan,d 1978-u Örebro universitet,Institutionen för medicinska vetenskaper,Pharmacology and Therapeutic Department, School of Health and Medical Sciences, Örebro University, Örebro, Sweden4 aut0 (Swepub:oru)sawn
7001 a Näslund, Eriku Karolinska Institutet4 aut
7001 a Thorell, Andersu Karolinska Institutet4 aut
7001 a Näslund, Ingmaru Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden4 aut
7102 a Örebro universitetb Institutionen för medicinska vetenskaper4 org
7730 t JAMA Surgeryd : American Medical Association (AMA)g 158:7, s. 709-717q 158:7<709-717x 2168-6254x 2168-6262
8564 u https://doi.org/10.1001/jamasurg.2023.1042y Fulltext
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-105910
8564 8u https://doi.org/10.1001/jamasurg.2023.1042
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:152677380

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