Long-term consequences of not closing the mesenteric defect after laparoscopic right colectomy

Abstract

Purpose: The controversy regarding closing the mesenteric defect after laparoscopic right colectomy remains a subject of debate. This study describes the consequences of not closing the mesenteric defect.

Methods: A 7-year prospective database revealed 530 consecutive patients who underwent laparoscopic right colectomy for neoplasia. No mesenteric defects were closed. Small bowel obstruction was determined by clinical assessment and diagnostic imaging. Statistical analysis included the Student t test and Mann-Whitney U test.

Results: On average, the 530 patients (44% male) were 69.6 years old +/- 12.5 years with American Society of Anesthesiologists' category 2, body mass index 26.6 +/- 5.7, operative time 175 +/- 65 minutes, incision length 5.7 +/- 3.0 cm. Thirty-six patients (6.8%) were converted. Median length of stay was 5 days (interquartile range 4-7). Median follow-up was 20 months (interquartile range 8-45). Four patients (0.8%) had complications attributed to the mesenteric defect: 2 had small bowel obstruction due to internal herniation and 2 had torsion of the anastomosis through the defect. Twenty-six patients (4.9%) had a small bowel obstruction during the follow-up period. Nonoperative treatment was successful in 12 patients. In the 14 patients who were operated on, small bowel obstruction was due to adhesions (4), incarcerated abdominal wall hernias (4), mesenteric defect (4), and cancer recurrence (2). The small bowel obstruction group (n = 26) had a significantly higher percentage of males than the non-small bowel obstruction group (n = 504; 69% vs 43%; P = .008).

Conclusions: These data do not support routinely closing the mesenteric defect after laparoscopic right colectomy for neoplasia. Additional studies with extended long-term follow-up are needed.