Mesenteric Defects Closure Using N-Hexyl-Cyanoacrylate Surgical Glue During Roux-en-Y Gastric Bypass: A Single-Center Observational Study.

Background and objective Small bowel obstruction (SBO) with internal hernia (IH) is a life-threatening complication following minimally invasive Roux-en-Y gastric bypass (mRYGB). IH occurs frequently within the first two to three years after surgery, with an incidence ranging from 0.5% to 9%. Mesenteric defect closure (MDC) is consistently recommended. However, the technique remains controversial. Suturing, which is the most commonly used technique, can be risky due to mesenteric hemorrhage and hematoma. Glue application for MDC may offer an alternative. The objective of this observational study was to report the incidence of IH after the routine use of surgical glue for MDC during mRYGB. Methods We conducted an observational study to investigate this topic. From January 2020 to January 2022, a total of 170 consecutive patients who underwent mRYGB with surgical glue used for MDC were prospectively followed, and their data were analyzed. Results The mean age of the cohort was 43 ± 10 years. The mean BMI was 43 ± 3 kg/m². Laparoscopic RYGB was performed in 79% of patients, while robotic mRYGB accounted for 20%. The mean excess weight loss was 14 ± 16%. The median glue application time was eight minutes (range: 6-10 minutes), including application and polymerization time. The mean follow-up duration was 42 months (range: 17-71 months); 80% of patients had more than 24 months of follow-up. No clinically significant IH was observed during the follow-up period, while one patient underwent surgery for acute SBO without IH. Conclusions The preliminary results of MDC using surgical glue during mRYGB are promising in terms of feasibility and tolerance. The absence of IH observed during this follow-up is noteworthy but should be interpreted with caution due to the presence of potential biases. Further multi-institutional prospective studies are needed to gain deeper insights into the topic.