A best evidence topic in surgery was written according to a structured protocol. The question asked was whether the closure of the mesenteric defects during laparoscopic gastric bypass via antecolic approach for morbid obesity reduces the incidence of symptomatic internal herniation. 251 papers were found using the reported search strategy of which three papers best represented the answer to the question. All three studies showed that by closuring the mesenteric defects, resulted in a reduction in the incidence of symptomatic internal hernias. One study showed there to be new complications arising from primary closure, but this was undetermined statistically. The evidence still however remains limited regarding the need for closure of mesenteric defects in gastric bypass operations. We recommend there is a need for large scale randomized control trials with suitable follow up for patients.
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http://dx.doi.org/10.1016/j.ijsu.2013.01.005 | DOI Listing |
BMJ Case Rep
January 2025
Department of Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines.
We present the case of a man in his 60s with hypertension, who had a 3-year history of an irreducible mass in the left inguinal area. The patient presented at the emergency room with left lower quadrant pain and scrotal pain. The clinical examination was not suggestive of an acute abdomen.
View Article and Find Full Text PDFUpdates Surg
January 2025
Bariatric Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy.
The rising prevalence of obesity has led to an increase in bariatric procedures, with laparoscopic Roux-en-Y gastric bypass (LRYGB) being one of the most commonly performed surgeries due to its efficacy and safety. However, internal hernia (IH) remains a significant complication post-LRYGB. The debate over preventive closure of mesenteric defects (MD) during LRYGB continues, with no consensus on the optimal technique.
View Article and Find Full Text PDFBMJ Case Rep
January 2025
Upper Gastrointestinal Surgery Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
The Arc of Bühler (AoB) is a rare anatomical variant in gastrointestinal vasculature where there is an aberrant anastomotic vessel between coeliac and superior mesenteric arteries. We present a rare case where AoB was noted intraoperatively to have haemodynamically significant flow in the context of coeliac artery stenosis, supplementing arterial supply to the hepatic artery proper via the gastroduodenal artery (GDA). An interpositional jump graft between the aorta and the GDA stump was created using the long saphenous vein, and flow was restored.
View Article and Find Full Text PDFUnlabelled: Transmesenteric hernia is an internal hernia without a sac caused by a congenital defect of the mesentery. It is a rare cause of intestinal atresia, usually diagnosed intraoperatively, therefore, its prognosis is variable and may be associated with high morbidity and mortality.
Objective: To report a case of transmesenteric hernia with multiple intestinal atresia of late diagnosis.
Am J Gastroenterol
January 2025
Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, Shanghai, China.
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