Cirugía Española

Cirugía Española

Volume 82, Issue 2, August 2007, Pages 77-88
Cirugía Española

Artículo especial
Cierre mesentérico en el bypass gástrico laparoscópico: técnica quirúrgica y revisión de la literatureMesenteric closure in laparoscopic gastric bypass: surgical technique and literature review

https://doi.org/10.1016/S0009-739X(07)71673-1Get rights and content

Resumen

A pesar de las ventajas del abordaje laparoscópico en la cirugía de la obesidad, se ha descrito el aumento de una complicación poco habitual en la cirugía abierta: las hernias internas. La mayoría de las publicaciones sobre hernias internas tratan sobre su incidencia y su forma de presentación, pero pocas nos describen cómo prevenirlas. En este artículo, presentamos una técnica para el cierre de los defectos mesentéricos en el bypass gástrico laparoscópico con Y de Roux retrocólica, mediante sutura continua e irreabsorbible (ethibond). Revisamos la literatura buscando en MEDLINE (palabras clave: obesidad, laparoscopia, bypass gástrico, hernia interna, hernia de Petersen) y en referencias de artículos de interés con el propósito de discutir la incidencia real de este problema.

Nuestra técnica es reproducible y disminuye la incidencia de estas complicaciones, aunque es necesario analizar nuestra serie en un futuro para saber si realmente las elimina. Estos resultados óptimos basados en el cierre mesentérico protocolizado han sido corroborados por otros autores.

Despite the advantages offered by laparoscopy in bariatric surgery, the incidence of a new complication that was uncommon in the previous era of open surgery –internal hernias– has increased. Most publications in the literature dealing with internal hernia describe the incidence and form of presentation of this entity but few explain how these complications can be prevented. In this review article we describe a technique to close mesenteric defects in retrocolic Roux-en-Y laparoscopic gastric bypass with permanent, continuous running suture (ethibond). We also review the literature in MEDLINE (www.ncbi.nlm.nih.gov/ entrez/ using the key words: obesity, laparoscopy, gastric bypass, internal hernia, Petersen hernia) and references from articles of interest to determine the real incidence of this complication.

Our technique has proven to be safe, reliable and reproducible and has greatly diminished the incidence of internal hernias. However, our data need to be analyzed in the future to determine whether the technique described eliminates this complication. The optimal results achieved with complete closure of all mesenteric defects have also been observed by other authors.

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