Mesenteric defect closure versus non-closure after complete mesocolic excision in minimally invasive right colectomy: a retrospective study.

BACKGROUND

The optimal management of the mesenteric defect after minimally invasive right hemicolectomy remains controversial, particularly in the setting of complete mesocolic excision (CME), where a large mesenteric defect is created. This study was aimed at evaluating whether mesenteric defect closure after CME reduces postoperative complications and whether the closure itself introduces additional risks.

METHODS

A single-center retrospective study was conducted using a prospectively maintained database of patients with stage II-III right colon cancer who underwent minimally invasive right hemicolectomy with CME between May 2022 and July 2025. Patients were divided into two groups according to whether the mesenteric defect was closed or left open. Demographic, operative, and postoperative outcomes were analyzed, including postoperative ileus (POI), internal herniation, small bowel obstruction, operative time, and length of hospital stay.

RESULTS

A total of 87 patients were included: 46 underwent mesenteric defect closure, and 41 did not. Baseline characteristics were comparable between groups. Postoperative gastrointestinal bleeding occurred in eight patients (9%), while two patients (2.3%) developed anastomotic leakage, one in each group. No symptomatic internal hernias or small bowel obstructions were observed. POI occurred in three patients (3.5%) with similar incidence between groups. Operative time, bowel recovery, harvested lymph nodes, and length of hospital stay did not differ significantly. No complications related to mesenteric defect closure were observed.

CONCLUSIONS

Mesenteric defect closure after minimally invasive right hemicolectomy with CME appears safe but does not significantly reduce postoperative morbidity. Given the low incidence of internal herniation, routine closure may not be necessary.