Closure of mesenteric defects using the Endoscopic Hernia Multifeed Stapler
- owenhaskins
- May 12
- 2 min read
Small bowel obstruction due to internal hernia is one of the most common and potentially serious complications following laparoscopic Roux-en-Y gastric bypass (LRYGB). It has been reported that complete closure of mesenteric defects (Petersen’s space and the jejunal mesenteric defect) in LRYGB results in a significant reduction in internal mesenteric hernias (non-closure 11.7% vs. closure: 2.5%)(1) and the reported risk of complication caused by closure of the mesenteric defects is low(1,2).
According to Dr Ruben Van Veen from OLVG West Amsterdam, Amsterdam, Netherlands, primary closure of mesenteric defects should be viewed as a routine part of that operation, which can be performed safely and effectively using the Endoscopic Hernia Multifeed Stapler (Bariatric Solutions International). Having closed more than 500 defects, Dr Ruben Van Veen said that he always closes the defects using the Endoscopic Hernia Multifeed Stapler, as opposed to suturing, as he believes stapling is a simpler, quicker and more effective procedure. More importantly, he stated that stapling reduces the risk of mesenteric bleeding and kinking of the bowel, reducing the risk of bowel obstruction, compared with suturing.
“The only time I might use suturing over stapling is if there is less tissue. You want the defects to be closed for a long period. The patient will need to make sufficient tissue to close the defects and aid the healing process. So, if I have a patient with defects I am closing for the second or the third time, I might use suturing to have extra reinforcement. However, another option is to use 20 staples, instead of the standard ten staples.”
Prior to using the Endoscopic Hernia Multifeed Stapler, Dr Ruben Van Veen used Medtronic’s Multifire Endo Hernia Stapler; however, he said this device was preloaded with only ten staples, so it was time-consuming due to the need to reload. An advantage of the Endoscopic Hernia Multifeed Stapler is that it is preloaded with 20 titanium staples, so in most cases, he can close both defects without any instrument exchange.
Overall, he commented that when closing mesenteric defects, there are two important aspects for surgeons to consider – time consumption and ease of use. Closing mesenteric defects with the Endoscopic Hernia Multifeed Stapler device addresses both concerns – it is both technically unchallenging, adding only four minutes to the total operating time and can be applied in all patients without affecting complication rates.
“In the future, I would like to see an increase in the number of staplers per device, and I know that Bariatric Solutions International is already striving to do that. This would be a helpful enhancement for those cases where extra reinforcement is required.”
References
Aghajani E, Nergaard BJ, Leifson BG, Hedenbro J, Gislason H. The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017 Sep;31(9):3743-3748. doi: 10.1007/s00464-017-5415-2. Epub 2017 Feb 15. PMID: 28205037; PMCID: PMC5579176.
Kristensen SD, Floyd AK, Naver L, Jess P. Does the closure of mesenteric defects during laparoscopic gastric bypass surgery cause complications? Surg Obes Relat Dis. 2015 Mar-Apr;11(2):459-64. doi: 10.1016/j.soard.2014.10.013. Epub 2014 Oct 22. PMID: 25813753.
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