The effect of mesenteric defect closure on internal hernias and small bowel obstruction in patients undergoing colorectal surgery: A systematic review and meta-analysis

Haltmeier, T.; Destefani, T.; Holzgang, M.; Kohler, A.; Candinas, D.; Brügger, L. (28 May 2021). The effect of mesenteric defect closure on internal hernias and small bowel obstruction in patients undergoing colorectal surgery: A systematic review and meta-analysis. The British journal of surgery, 108(Supplement_4). Wiley 10.1093/bjs/znab202.016

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Objective: Internal hernias (IH) are potentially severe complications after colorectal surgery and may lead to small bowel obstruction (SBO).
However, the impact of mesenteric defect closure (MDC) on IH and SBO
is currently unclear. The aim of this systematic review and meta-analysis was, therefore, to investigate the effect of MDC on IH and SBO in
patients undergoing laparoscopic and open colorectal surgery.
Methods: Ovid Medline, PubMed, and Embase databases were
searched. Studies reporting MDC in colorectal surgery were enclosed in
the systematic review. Meta-analysis included studies that assessed
the effect of MDC vs. non-closure (non-MDC) on IH and SBO. Metaanalysis was performed using a random effect model. Results of individual studies were summarized as ranges. Effect sizes were described
as odds ratios (OR) with 95% confidence intervals (CI).
Results: Literature search revealed a total of 344 abstracts. Of these, 16
studies met the inclusion criteria. Included studies comprised a total of
10,068 patients and were published between 2009 and 2019. The incidence of IH and SBO as a composite outcome ranged from 0.0 to 3.5%,
whereas the incidence of IH and SBO as single outcomes ranged from
0.0 to 2.7% and 0.0 to 1.7%, respectively. If IH occurred, reoperation was
required in 66-100% with additional bowel resections in 20-100% and
stoma-formation in 17-50%. The complication rate after reoperations
was 25-100% and mortality 0-25%. Meta-analysis including four studies
revealed no statistically significant effect of MDC on the composite outcome of IH and SBO (OR 0.25, 95% CI 0.04-1.77) and SBO as a single outcome (three studies, OR 0.48, 95% CI 0.04-5.49). The risk for IH as a
single outcome was significantly lower in the MDC group (three studies,
OR 0.15, 95% CI 0.02-0.92). Heterogeneity of the studies included was
low to moderate for the composite outcome, as well as for IH and SBO
as single outcomes (I2 40.3%, 0.0%, and 45.7%, respectively).
Conclusion: In current meta-analysis, MDC was not significantly associated with the composite outcome of IH and SBO in patients undergoing colorectal surgery. However, MDC significantly reduced the risk for
IH. Based on these results, the benefit of MDC in colorectal surgery
remains unclear and needs to be addressed in further studies.

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