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Background: Internal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) to prevent IH in the LRYGB remains controversial., Objectives: The main objective of our study was to evaluate the risk of reopening at the level of both MDs, the Petersen space, and the intermesenteric gap., Setting: University hospital., Methods: Prospective cohort of patients with a history of LRYGB, all with closure of both MDs, and in whom another intra-abdominal surgery was performed after the LRYGB, between January 2013 and December 2018. The status of both MDs was recorded. All analyses were performed with Stata version 15 software with a level of significance of .05., Results: A total of 76 patients were included. The average time that elapsed between the LRYGB and the surgery that evaluated the state of the MDs was 22.8 months. The patients lost on average 34.7 kg, with a minimum of 8 kg and a maximum of 76 kg. The indications for the interventions were cholelithiasis (68.3%), recurrent abdominal pain (13.2%), intestinal obstruction (11.8%), malabsorption syndrome (7.3%), and bilateral inguinal hernia (2.4%). At the time of surgery, 52 patients (68.4%) had a completely closed Petersen space; 58 patients (76.3%) had a completely closed intermesenteric defect. Both MDs were closed in 36 patients (47.4%), and 33 patients (43.4%) had at least 1 of the MDs open., Conclusion: The closure of MDs eliminated the risk of IH in half of the operated patients of LRYGB in this series., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue., (Copyright © 2011 Elsevier Ltd. All rights reserved.)