Endoscopic Hernia Multifeed Stapler 



Closure of Mesenteric Defects in
Laparoscopic Roux-en-Y Gastric Bypass
in order to Prevent Internal Hernias


Video 1: Closure of Petersen’s space (Dr. van Veen)


Small bowel obstruction due to internal hernia is the most common and potentially serious complication after laparoscopic Roux-en-Y gastric bypass [1,2,6,7].

Complete closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass results in a significant reduction in internal mesenteric hernias [3,5,7].

The reported risk of complication caused by closure of the mesenteric defects is low [4,7]. Primary closure of mesenteric defects can be performed safely and should be viewed as a routine part of that operation [2,7].

Symptoms of internal hernia:
  • Vague colic pain
  • Mostly pain in left abdomen
  • Intermittant character

Incidence of internal hernia [7]:

  • Non-closure: 11,7%
  • Closure: 2,5%
In 2010, a new and simplified technique of closing the mesenteric defects was introduced using a stapler device [9]. Two aspects to consider with regards to the closure of the mesenteric defects is time consumption and ease of use [7]. Suturing may also entail increased risk for mesenteric hematomas and anatomical disturbances causing secondary kinking and bowel obstruction [2,4].Closing the mesenteric defects with a stapler device is technically unchallenging and adds only 4 minutes to the total operating time and can be applied in all patients without affecting complication rate [7].Please review the images below on how the EHMS of Novisurge can be used to close Petersen’s space and the jejunal mesenteric defect after laparoscopic Roux-en-Y gastric bypass to prevent internal hernias.
Closure of jejunal mesenteric defect
Closure of Petersen’s space
On average a bariatric or metabolic surgeon will require 14-16 staples of the EHMS to close both mesenteric defects with a double-layer. Given the fact that the EHMS is preloaded with 20 titanium staples enables the bariatric or metabolic surgeon to close both defects without any instrument exchange and/or disruption of the surgical flow.

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