Clinical Significance of Closure of Mesenteric Defects in Laparoscopic Colectomy

Shimada, Masahiko; Sakaguchi, Yoshihisa; Oki, Eiji; Kusumoto, Eiji; M, Ota; Kimura, Yasue; Tsutsumi, Norifumi; Kusumoto, Tetsuya; Izutsu, Koji; Maehara, Yoshihiko

doi:10.1097/sle.0000000000000234

Cited by 6 publications

(22 citation statements)

References 18 publications

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“…They found two cases of intestinal obstruction due to IH through the mesenteric defect. 27 In both patients, who required reoperations, the mesocolon defect had not been corrected in the first surgery. When comparing the duration of intervention and the blood loss, they found no differences, but with a significant lower rate of reoperations in patients where the defect was corrected.…”

Section: Discussionmentioning

confidence: 93%

“…4,10,15 Those who believe that correction of the mesocolon defect also remember that there was a significant reduction in the number of IH cases after bariatric surgeries, once the mesenteric defect was systematically closed. Sugiyama et al 27 with the aim to evaluating the importance of the correction of mesocolon defect, evaluated 58 patients consecutively submitted to proximal colectomy. In 30 patients the opening was closed, whereas in 28 the defect was not corrected.…”

Section: Discussionmentioning

confidence: 99%

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Internal hernia through mesocolon defect after left laparoscopic colectomy

Camargo

Cervantes

Ayrizono

et al. 2019

Journal of Coloproctology

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Introduction The development of internal hernias due to the mesocolon defect after laparoscopic colectomy is a rare complication with only 39 cases described. There are controversies whether the closure of the defect of the mesocolon after resection of the colon could prevent the development of this complication. Objective To describe a case of intestinal obstruction due to internal hernia through the mesocolon defect after laparoscopic rectosigmoidectomy and to perform a literature review. Case report A 59-year-old woman was hospitalized for laparoscopic rectosigmoidectomy due to an adenocarcinoma located in the rectosigmoid junction. She underwent a rectosigmoidectomy by laparoscopy, with an extracorporeal mechanical anastomosis, without closure of the mesocolon defect. In the fifth postoperative day the patient presented an intestinal obstruction due to an internal hernia through the mesocolon defect confirmed by computerized tomography. During the exploratory laparotomy approximately 120 cm jejunum was identified through the mesocolon defect. The reduction of herniated small bowel was done without the need of intestinal resection. The mesocolon defect was corrected by continuous suture. After the reoperation, the patient presented a favorable recovery being discharged on the fifth day. Conclusion Intestinal obstruction due to internal hernia after laparoscopic rectosigmoidectomy is a rare postoperative complication that can be avoided by the adequate closure of the mesocolon defect.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Internal hernia through mesocolon defect after left laparoscopic colectomy

Camargo

Cervantes

Ayrizono

et al. 2019

Journal of Coloproctology

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“…In the unclosed group, 2 patients had intestinal obstruction, and 1 patient had surgical site infection and needed to be repeated surgery, the reoperation rate is higher than that of the closed group (11% vs 0%, P = 0.033). Closing the mesenteric defects does not prolong the operation time and increase surgical bleeding, which may bene t patients (20). Therefore, based on the above-mentioned literature, some experts believe that although the incidence is not high, the mesenteric defects needs to be closed during surgery, which has prevented serious postoperative complications from occurring, thus requiring reoperation.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of the Influence of Closure of Mesenteric Defects on Complications During Laparoscopic Radical Resection of Right Colon Cancer

Wang

et al. 2020

Preprint

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Background: The influence of closure of mesenteric defects during laparoscopic radical resection of right colon cancer is still controversial.Methods: A total of 66 patients who were received laparoscopic radical resection of right colon cancer in our hospital were enrolled. The statistics of complications, included Postoperative Length of Stay, Exhaust time after surgery, Defecation time after surgery, Intraoperative blood loss, Length of incision, Length of operation, Lung infection, Abdominal infection, Anastomotic bleeding and Anastomotic leakage were examined.Results: The mesenteric defects were closed in 35 patients in Clousure group and not closed in 31 patients in Nonclosure group.The difference between two group included Total complication, Postoperative length of stay, Exhaust time after surgery, Defecation time after surgery, Length of operation, Lung infection, Abdominal infection, Anastomotic bleeding and Anastomotic leakage are not significant (p>0.05).Conclusion: Whether to close the mesenteric defects during laparoscopic radical resection of right colon cancer does not affect the rate of comlications.

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“…In our study, most patients with early postoperative small bowel obstruction improved with conservative treatment, and surgical treatment was rarely needed. On the other hand, Sugiyama et al supported the closure of mesenteric defects after laparoscopic right colectomy because serious complications requiring reoperation occurred only in the nonclosure group [ 20 ]. Moreover, the procedure for closing the defect did not extend the operation time or increase the bleeding.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Consequences of Nonclosure of Mesenteric Defects after Traditional Right Colectomy

Tsai

Lai

Lee

et al. 2018

BioMed Research International

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Background There are still discrepancies among general/colorectal surgeons regarding closure of mesenteric defect in scientific literature. This study aimed to assess the long-term consequences of nonclosure of the mesenteric defect after open right colectomy. Methods A 7-year retrospectively collected and continuous database revealed 212 consecutive patients who had undergone traditional right colectomy without closing the mesenteric defects at Kaohsiung Chung-Gung Memorial Hospital; all patients were operated by a single surgeon. Among these patients, 17 were excluded (those who died within 30 days after surgery or those who received an end ileostomy). The mean age of the 195 patients (58% men and 42% women) was 61.6 ± 12.6 years, and the follow-up period was 4.1 ± 2.8 years (interquartile range 0.09 ~ 10.4). Results Forty-four patients (22.5%) encountered intestinal obstruction. Nine (20.4%) required surgical intervention. The cause of intestinal obstruction was adhesion (n=1), ventral hernia (n=1), and cancer recurrence (n=7). Conservative treatment was successful in 35 patients. The intestinal obstruction group (n = 44) were similar to the no-intestinal obstruction group (n = 151) in terms of the following parameters: age, sex, previous abdominal surgery, indication for colectomy, and procedure related complications. Carcinomatosis was found to increase the incidence of intestinal obstruction. No patient developed intestinal obstruction because of the nonclosure of mesenteric defects after right colectomy. Conclusion This study suggested that routine procedure of closing the mesenteric defect after open right colectomy might not be beneficial. Additional studies with extended long-term follow-up periods are needed to confirm the benefits of the nonclosure.

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Clinical Significance of Closure of Mesenteric Defects in Laparoscopic Colectomy

Abstract: Serious complications requiring reoperation occurred only in the nonclosure group. The procedure for closing the defect did not extend the operation time or increase the bleeding.

Cited by 6 publications

References 18 publications

Internal hernia through mesocolon defect after left laparoscopic colectomy

Internal hernia through mesocolon defect after left laparoscopic colectomy

Retrospective Analysis of the Influence of Closure of Mesenteric Defects on Complications During Laparoscopic Radical Resection of Right Colon Cancer

Long-Term Consequences of Nonclosure of Mesenteric Defects after Traditional Right Colectomy

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Clinical Significance of Closure of Mesenteric Defects in Laparoscopic Colectomy

Abstract: Serious complications requiring reoperation occurred only in the nonclosure group. The procedure for closing the defect did not extend the operation time or increase the bleeding.

Cited by 6 publications

References 18 publications

Internal hernia through mesocolon defect after left laparoscopic colectomy

Internal hernia through mesocolon defect after left laparoscopic colectomy

Retrospective Analysis of the Influence of Closure of Mesenteric Defects on&nbsp;Complications During Laparoscopic Radical Resection of Right Colon Cancer

Long-Term Consequences of Nonclosure of Mesenteric Defects after Traditional Right Colectomy

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Retrospective Analysis of the Influence of Closure of Mesenteric Defects on Complications During Laparoscopic Radical Resection of Right Colon Cancer