{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:28:19Z","timestamp":1792481299915,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"Importance<\/jats:title>Short-term and midterm data suggest that mesenteric defects closure during laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery reduces the risk of internal herniation with small bowel obstruction (SBO) but may increase risk of kinking of the jejunojejunostomy in the early postoperative period. However, to our knowledge, there are no clinical trials reporting long-term results from this intervention in terms of risk for SBO or opioid use.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate long-term safety and efficacy outcomes of closure of mesenteric defects during LRYGB.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This randomized clinical trial with a 2-arm, parallel, open-label design included patients with severe obesity scheduled for LRYGB bariatric surgery at 12 centers in Sweden from May 1, 2010, through November 14, 2011, with 10 years of follow-up after the intervention.<\/jats:p><\/jats:sec>Interventions<\/jats:title>During the operation, patients were randomly assigned 1:1 to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB or to nonclosure.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The primary outcome was reoperation for SBO. New incident, chronic opioid use was a secondary end point as a measure of harm.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 2507 patients (mean [SD] age, 41.7 [10.7] years; 1863 female [74.3%]) were randomly assigned to closure of mesenteric defects (n\u2009=\u20091259) or nonclosure (n\u2009=\u20091248). After censoring for death and emigration, 1193 patients in the closure group (94.8%) and 1198 in the nonclosure group (96.0%) were followed up until the study closed. Over a median follow-up of 10 years (IQR, 10.0-10.0 years), a reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure (10-year cumulative incidence, 14.9%; 95% CI, 13.0%-16.9%) and in 98 patients with closure (10-year cumulative incidence, 7.8%; 95% CI, 6.4%-9.4%) (subhazard ratio [SHR], 0.42; 95% CI, 0.32-0.55). New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure (10-year cumulative incidence, 20.4%; 95% CI, 17.7%-23.0%) and 166 of 895 opioid-naive patients with closure (10-year cumulative incidence, 18.7%; 95% CI, 16.2%-21.3%) (SHR, 0.90; 95% CI, 0.73-1.11).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This randomized clinical trial found long-term reduced risk of SBO after mesenteric defects closure in LRYGB. The findings suggest that routine use of this procedure during LRYGB should be considered.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT01137201<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2023.1042","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T15:34:48Z","timestamp":1683732888000},"page":"709","source":"Crossref","is-referenced-by-count":45,"title":["Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery"],"prefix":"10.1001","volume":"158","author":[{"given":"Erik","family":"Stenberg","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Ottosson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Magnuson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Szabo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Wall\u00e9n","sequence":"additional","affiliation":[{"name":"Pharmacology and Therapeutic Department, School of Health and Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"N\u00e4slund","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Thorell","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Surgery, Ersta Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingmar","family":"N\u00e4slund","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"soi230020r1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health effects of overweight and obesity in 195 countries over 25 years.","volume":"377","author":"Afshin","year":"2017","journal-title":"N Engl J Med"},{"issue":"9612","key":"soi230020r2","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/S0140-6736(08)60269-X","article-title":"Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.","volume":"371","author":"Renehan","year":"2008","journal-title":"Lancet"},{"issue":"3","key":"soi230020r3","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1038\/sj.ijo.0801919","article-title":"Impact of overweight and obesity on health-related quality of life\u2014a Swedish population study.","volume":"26","author":"Larsson","year":"2002","journal-title":"Int J Obes Relat Metab Disord"},{"issue":"3","key":"soi230020r4","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1111\/joim.12012","article-title":"Review of the key results from the Swedish Obese Subjects (SOS) trial\u2014a prospective controlled intervention study of bariatric surgery.","volume":"273","author":"Sj\u00f6str\u00f6m","year":"2013","journal-title":"J Intern Med"},{"issue":"12","key":"soi230020r5","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1056\/NEJMoa1700459","article-title":"Weight and metabolic outcomes 12 years after gastric bypass.","volume":"377","author":"Adams","year":"2017","journal-title":"N Engl J Med"},{"issue":"6","key":"soi230020r6","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1097\/SLA.0000000000001920","article-title":"Substantial decrease in comorbidity 5 years after gastric bypass: a population-based study from the Scandinavian Obesity Surgery Registry.","volume":"265","author":"Sundbom","year":"2017","journal-title":"Ann Surg"},{"issue":"5","key":"soi230020r7","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1007\/s11695-020-05207-7","article-title":"Bariatric Surgery Survey 2018: similarities and disparities among the 5 IFSO chapters.","volume":"31","author":"Angrisani","year":"2021","journal-title":"Obes Surg"},{"issue":"3","key":"soi230020r8","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1007\/s11605-020-04761-w","article-title":"Internal hernia after laparoscopic gastric bypass without preventive closure of mesenteric defects: a single institution\u2019s experience.","volume":"25","author":"Brammerloo","year":"2021","journal-title":"J Gastrointest Surg"},{"issue":"12","key":"soi230020r9","doi-asserted-by":"publisher","first-page":"5368","DOI":"10.1007\/s00464-019-07328-2","article-title":"Health benefits and risks during 10 years after Roux-en-Y gastric bypass.","volume":"34","author":"Chahal-Kummen","year":"2020","journal-title":"Surg Endosc"},{"issue":"4","key":"soi230020r10","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.soard.2010.10.019","article-title":"Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up.","volume":"7","author":"Higa","year":"2011","journal-title":"Surg Obes Relat Dis"},{"issue":"12","key":"soi230020r11","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1007\/s11695-011-0462-6","article-title":"Small bowel obstruction after antecolic antegastric laparoscopic Roux-en-Y gastric bypass without division of small bowel mesentery: a single-centre, 7-year review.","volume":"21","author":"Abasbassi","year":"2011","journal-title":"Obes Surg"},{"issue":"10026","key":"soi230020r12","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1016\/S0140-6736(15)01126-5","article-title":"Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial.","volume":"387","author":"Stenberg","year":"2016","journal-title":"Lancet"},{"issue":"2","key":"soi230020r13","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1093\/bjs\/znaa055","article-title":"Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery.","volume":"108","author":"Kristensen","year":"2021","journal-title":"Br J Surg"},{"issue":"11","key":"soi230020r14","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1016\/j.soard.2019.08.005","article-title":"Effect of the closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a prospective study.","volume":"15","author":"Samur","year":"2019","journal-title":"Surg Obes Relat Dis"},{"key":"soi230020r15","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.ijsu.2019.09.017","article-title":"Closure of mesenteric defects is associated with a higher incidence of small bowel obstruction due to adhesions after laparoscopic antecolic Roux-en-y gastric bypass: a retrospective cohort study.","volume":"71","author":"Nuytens","year":"2019","journal-title":"Int J Surg"},{"issue":"9","key":"soi230020r16","doi-asserted-by":"publisher","first-page":"2486","DOI":"10.1007\/s00464-014-3970-3","article-title":"Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial.","volume":"29","author":"Rosas","year":"2015","journal-title":"Surg Endosc"},{"issue":"3","key":"soi230020r17","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1381\/096089203765887679","article-title":"Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome.","volume":"13","author":"Olbers","year":"2003","journal-title":"Obes Surg"},{"key":"soi230020r18","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register.","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"5","key":"soi230020r19","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1111\/bcpt.2016.119.issue-5","article-title":"The first decade with the Swedish Prescribed Drug Register\u2014a systematic review of the output in the scientific literature.","volume":"119","author":"Wallerstedt","year":"2016","journal-title":"Basic Clin Pharmacol Toxicol"},{"issue":"2","key":"soi230020r20","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s10654-016-0117-y","article-title":"Registers of the Swedish total population and their use in medical research.","volume":"31","author":"Ludvigsson","year":"2016","journal-title":"Eur J Epidemiol"},{"key":"soi230020r21","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk.","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"issue":"8","key":"soi230020r22","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1007\/s11695-015-2028-5","article-title":"Internal herniation after laparoscopic Roux-en-Y gastric bypass surgery: pitfalls in diagnosing and the introduction of the AMSTERDAM classification.","volume":"26","author":"Geubbels","year":"2016","journal-title":"Obes Surg"},{"issue":"9","key":"soi230020r24","doi-asserted-by":"publisher","first-page":"3743","DOI":"10.1007\/s00464-017-5415-2","article-title":"The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique.","volume":"31","author":"Aghajani","year":"2017","journal-title":"Surg Endosc"},{"issue":"6","key":"soi230020r25","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1007\/s00464-015-4486-1","article-title":"Primary non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: reoperations and intraoperative findings in 146 patients.","volume":"30","author":"Delko","year":"2016","journal-title":"Surg Endosc"},{"issue":"12","key":"soi230020r26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009655","article-title":"To what extent are surgery and invasive procedures effective beyond a placebo response? a systematic review with meta-analysis of randomised, sham controlled trials.","volume":"5","author":"Jonas","year":"2015","journal-title":"BMJ Open"},{"issue":"1","key":"soi230020r27","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1097\/SLA.0000000000003163","article-title":"Pregnancy as a risk factor for small bowel obstruction after laparoscopic gastric bypass surgery.","volume":"272","author":"Stenberg","year":"2020","journal-title":"Ann Surg"},{"issue":"11","key":"soi230020r28","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1001\/jamasurg.2016.2334","article-title":"Evaluation of the association between preoperative clinical factors and long-term weight loss after Roux-en-Y gastric bypass.","volume":"151","author":"Wood","year":"2016","journal-title":"JAMA Surg"},{"issue":"9","key":"soi230020r29","doi-asserted-by":"publisher","first-page":"2609","DOI":"10.1007\/s11695-018-3223-y","article-title":"high-frequency of computer tomography and surgery for abdominal pain after Roux-en-Y gastric bypass.","volume":"28","author":"Sandvik","year":"2018","journal-title":"Obes Surg"},{"issue":"2","key":"soi230020r30","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/s11695-021-05778-z","article-title":"The influence of mesenteric defects closure on the use of computed tomography for abdominal pain 5 years after laparoscopic gastric bypass\u2014a post hoc analysis of a randomized clinical trial.","volume":"32","author":"Amanda","year":"2022","journal-title":"Obes Surg"},{"issue":"5","key":"soi230020r31","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1097\/SLA.0000000000005247","article-title":"The diagnostic accuracy of abdominal computed tomography in diagnosing internal herniation following Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis.","volume":"275","author":"Nawas","year":"2022","journal-title":"Ann Surg"},{"issue":"4","key":"soi230020r32","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1007\/s11695-018-03670-x","article-title":"Comparing techniques for mesenteric defects closure in laparoscopic gastric bypass surgery\u2014a register-based cohort study.","volume":"29","author":"Stenberg","year":"2019","journal-title":"Obes Surg"},{"issue":"2","key":"soi230020r33","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1097\/SLA.0000000000003356","article-title":"Prevalence and risk factors for chronic abdominal pain after Roux-en-Y gastric bypass surgery: a cohort study.","volume":"273","author":"Gormsen","year":"2021","journal-title":"Ann Surg"},{"issue":"6","key":"soi230020r34","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in US adults.","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg"},{"issue":"11","key":"soi230020r35","doi-asserted-by":"publisher","first-page":"3518","DOI":"10.1007\/s11695-018-3377-7","article-title":"Use of opioid analgesics before and after gastric bypass surgery in Sweden: a population-based study.","volume":"28","author":"Wall\u00e9n","year":"2018","journal-title":"Obes Surg"},{"issue":"10","key":"soi230020r36","doi-asserted-by":"publisher","first-page":"1544","DOI":"10.1016\/j.soard.2018.06.004","article-title":"Diagnosis and treatment of chronic abdominal pain 5 years after Roux-en-Y gastric bypass.","volume":"14","author":"Blom-H\u00f8gest\u00f8l","year":"2018","journal-title":"Surg Obes Relat Dis"},{"issue":"1","key":"soi230020r37","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s11695-017-2798-z","article-title":"Health-related quality-of-life after laparoscopic gastric bypass surgery with or without closure of the mesenteric defects: a post-hoc analysis of data from a randomized clinical trial.","volume":"28","author":"Stenberg","year":"2018","journal-title":"Obes Surg"},{"key":"soi230020r38","doi-asserted-by":"publisher","first-page":"f457","DOI":"10.1136\/bmj.f457","article-title":"Comparison of treatment effect sizes associated with surrogate and final patient relevant outcomes in randomised controlled trials: meta-epidemiological study.","volume":"346","author":"Ciani","year":"2013","journal-title":"BMJ"},{"issue":"17","key":"soi230020r39","doi-asserted-by":"publisher","first-page":"1579","DOI":"10.1056\/NEJMp1310102","article-title":"The randomized registry trial\u2014the next disruptive technology in clinical research?","volume":"369","author":"Lauer","year":"2013","journal-title":"N Engl J Med"},{"issue":"10026","key":"soi230020r40","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/S0140-6736(16)00098-2","article-title":"Is this laparoscopic technique study the perfect surgical trial?","volume":"387","author":"Bhangu","year":"2016","journal-title":"Lancet"},{"issue":"5","key":"soi230020r41","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1002\/bjs.10448","article-title":"Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database.","volume":"104","author":"Stenberg","year":"2017","journal-title":"Br J Surg"},{"issue":"3","key":"soi230020r42","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.soard.2020.10.017","article-title":"High acquisition rate and internal validity in the Scandinavian Obesity Surgery Registry.","volume":"17","author":"Sundbom","year":"2021","journal-title":"Surg Obes Relat Dis"},{"issue":"1","key":"soi230020r43","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/EDE.0b013e3181c1ea43","article-title":"The hazards of hazard ratios.","volume":"21","author":"Hern\u00e1n","year":"2010","journal-title":"Epidemiology"},{"key":"soi230020r23","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis","author":"Harrell","year":"2015","edition":"2nd ed"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2804882\/jamasurgery_stenberg_2023_oi_230020_1689122315.69121.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T15:06:33Z","timestamp":1689174393000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2804882"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2023,7,1]]},"references-count":43,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2023.1042","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7,1]]}}}