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

Abstract

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.

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

“…A retrospective study of 195 patients showed that no patients had intestinal obstruction due to patent mesenteric defect after right hemicolectomy. Routine suture of mesenteric defect after operation may not bene t patients (8). A study of 530 patients showed that mesenteric defects caused complications in 4 cases (0.8%), of which 2 cases had intra-abdominal hernias causing small bowel obstruction, and 2 cases caused anastomotic torsion due to defects, but the overall study data cannot support that is beni cial for patients to close mesenteric defect (16).…”

“…Compared with traditional surgery, laparoscopic colon surgery has the advantages of less pain, small incision, rapid recovery, and short fasting time, and the effect of tumor treatment is equivalent to traditional surgery (3)(4)(5). However, there is controversy about whether to close the mesenteric defects after laparoscopic radical resection of colon cancer (6)(7)(8). The unclosed mesenteric defects after radical resection of right colon cancer may lead to complications such as hernia, volvulus, and intestinal obstruction (6).…”

Internal Hernia After Laparoscopic Left Colectomy: Case Series and Review of the Literature

“…11 Similar findings were also reported by Tsai et al, who suggested that routine closure of the mesenteric defect after laparoscopic right colectomy might not be beneficial. 12 In the case of laparoscopic left colectomy, Sereno-Trabado et al suggest that all mesenteric defects created during laparoscopic colorectal surgery should be closed given the high mortality rate associated with internal herniation (20%). 2,4…”

Ileocolic Anastomoses

“…A 2010 cohort study of 530 patients undergoing laparoscopic right hemicolectomy found that four patients in the study developed small bowel obstruction due to the mesenteric defect, which the authors argued did not support closing mesenteric defects laparoscopically. 37 38 39 Other studies demonstrated that closure of mesenteric defects after partial colectomy may in fact be associated with increased risk of postoperative complications such as bowel obstruction. 40 Since the risk of internal hernia is very low after laparoscopic colon resection, 41 it is likely safe to assume that risk of internal hernia is low in open resection as well, thus perhaps not necessitating mesenteric window closure after open ileocolic anastomosis.…”