Preventing Peterson’s space hernia using a BIO synthetic mesh

BMC Surgery

Adam Skidmore¹  Edo O. Aarts² 

[1] Department of General Surgery, Victorian Obesity Surgery Centre, Localized in Warringal Hospital and Knox Private Hospital, 5 Burgundy Street, Heidelberg, 3084, Melbourne, VIC, Australia;WeightWorks Clinics, Surgical weight Loss Clinic, Amersfoort, The Netherlands;

关键词: Roux-en-Y gastric bypass;    RYGB;    Internal hernia;    Hernia;    Glue;    BIO synthetic mesh;    Mesh;   

DOI  :  10.1186/s12893-021-01197-0

来源: Springer

【 摘 要 】

BackgroundInternal hernias occur after Roux-en-Y gastric bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created. The closure technique used is related to the internal hernia risks outcomes. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. By closing over a BIO mesh, the risk might be reduced even more.SettingTwo large private hospitals specialized in bariatric surgery.MethodsAll patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In all patients, the entero-enterostomy (EE) was closed using a double layered non-absorbable suture. In 2014, Peterson’s space was closed exclusively using glue, the years hereafter in a similar fashion as the EE, combined with a piece of glued BIO Mesh.ResultsThe glued RYGB patients showed 25% of patients with an internal hernia (14%) or open Peterson’s space compared to 0.5% of patients (p < 0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although this was an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to the firm adhesion formation.ConclusionGluing the intermesenteric spaces is not beneficial but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is above all safe, effective and led to an almost complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture should give more insights into which is the optimal closure technique.

【 授权许可】

CC BY