Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 4;21(1):236.
doi: 10.1186/s12893-021-01197-0.

Preventing Peterson's space hernia using a BIO synthetic mesh

Adam Skidmore  1 , Edo O Aarts  2
Affiliations

Preventing Peterson's space hernia using a BIO synthetic mesh

Adam Skidmore et al. BMC Surg. .

Erratum in

Abstract

Background: Internal hernias occur after Roux-en-Y gastric bypass surgery (RYGB) when small bowel herniates into the intermesenteric spaces that have been created. The closure technique used is related to the internal hernia risks outcomes. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. By closing over a BIO mesh, the risk might be reduced even more.

Setting: Two large private hospitals specialized in bariatric surgery.

Methods: All patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In all patients, the entero-enterostomy (EE) was closed using a double layered non-absorbable suture. In 2014, Peterson's space was closed exclusively using glue, the years hereafter in a similar fashion as the EE, combined with a piece of glued BIO Mesh.

Results: The glued RYGB patients showed 25% of patients with an internal hernia (14%) or open Peterson's space compared to 0.5% of patients (p < 0.001) who had a combined sutured and BIO Mesh Closure of their Peterson's space defect. Although this was an ideal technique for Peterson's space, it led to 1% of entero-enterostomy kinking due to the firm adhesion formation.

Conclusion: Gluing the intermesenteric spaces is not beneficial but placing a BIO Mesh in Peterson's space is a promising new technique to induce local adhesions. It is above all safe, effective and led to an almost complete reduction of Peterson's internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture should give more insights into which is the optimal closure technique.

Keywords: BIO synthetic mesh; Glue; Hernia; Internal hernia; Mesh; RYGB; Roux-en-Y gastric bypass.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
View of Peterson’s space after closure with BIO-A mesh with interrupted vicryl sutures
Fig. 2
Fig. 2
View of Peterson’s space two years after closure with BIO-A mesh
See this image and copyright information in PMC

References

    1. Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967;47:1345–1351. doi: 10.1016/S0039-6109(16)38384-0. - DOI - PubMed
    1. Stenberg E, Szabo E, Agren G, et al. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Ann Surg. 2014;260:1040–1047. doi: 10.1097/SLA.0000000000000431. - DOI - PubMed
    1. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–3794. doi: 10.1007/s11695-018-3450-2. - DOI - PubMed
    1. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–289. doi: 10.1097/00000658-200109000-00002. - DOI - PMC - PubMed
    1. Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux en Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–1271. doi: 10.1381/096089206778663689. - DOI - PubMed