Novel technique using a bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia

Abstract

Introduction: Laparoscopic Roux-en-Y gastric bypass is a bariatric operation that is effective for long-term weight loss. Although rare, one serious complication is an internal hernia through Petersen’s space, which may result in bowel strangulation. Although the incidence of internal hernia can be reduced through closing the Petersen’s defect, it does not eliminate the risk. This case describes a novel and reliable method to close Petersen’s defect. We report the case of a 30-year-old female who underwent a laparoscopic Roux-en-Y gastric bypass for the management of morbid obesity. Following her Roux-en-Y reconstruction, a prosthetic bioabsorbable mesh was placed in Petersen’s space and reinforced with fibrin glue to prevent internal herniation through Petersen’s defect. The use of a bioabsorbable mesh in Petersen’s space is a novel and easy technique that could be used to reduce the incidence of an internal hernia through Petersen’s defect.

Absorbable suture can be effectively and safely used to close the mesenteric defect in a gastric bypass Sprague-Dawley rat model

“…Many materials are currently being used by surgeons to close the mesenteric defects. These include various non-absorbable sutures, stapler, biological glue, hernia mesh, hernia clips and so on [4,9,11,[19][20][21]. Some surgeons are accustomed to closing the mesenteric defects using prolene sutures because of its non-absorbability and smoothness.…”

“…Therefore, it is feasible to use the glue to close the mesenteric defect, but the risk of intestinal and surrounding tissue adhesion is high, likely because it is difficult to control the amount of glue during application. But, in the study by Mark Magdy et al, [20] they closed the Petersen's space mesentery defect using bioabsorbable mesh with fibrin glue fixation with a good result.…”

Absorbable suture can be effectively and safely used to close the mesenteric defect in a gastric bypass Sprague-Dawley Rat Model

“…Many materials are used to close mesenteric defects, including various non-absorbable sutures, stapler, biological glue, hernia mesh, hernia clips and so on [4,6,8,[15][16][17]. Some surgeons are accustomed to closing the mesenteric defects using prolene sutures because of its non-absorbability and smoothness, but our experiment results indicated that adhesion in prolene group was minimum, and importantly, we found gaps formed between the suture and mesentery along the suture line likely indicating that using prolene sutures may not be safe to close the mesenteric defect probably because of the light tissue response and little adhesion.…”

“…Therefore, it is feasible to use the glue to close the mesenteric defect, but the risk of intestinal and surrounding tissue adhesion is high, likely because it is difficult to control the amount of glue during application. However, Mark Magdy et al closed Petersen's space using bioabsorbable mesh with fibrin glue fixation with a good result [16].…”

Imaging appearance on CT post laparoscopic Roux-en-Y gastric bypass using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia

“…This case report describes a new bariatric surgical technique and the associated post-operative radiological appearances on CT. The surgical technique has been pioneered in Sydney, Australia 5 and involves a laparoscopic RYGB using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia.…”