Meta-analysis Of The Mesenteric Defect Closure In Laparoscopic Antecolic Roux-en-Y Anastomosis To Prevent Postoperativemesenteric Hernia

Objectives:The main purpose of this study was to systematically evaluate the Feasibility of mesenteric defect closure in laparoscopic antecolic Roux-en-Y anastomosis to prevent mesenteric hernia.Furthermore,mesenteric defects were further confirmed as the main predisposing factors of postoperative mesenteric hernia.Method:Retrieving the official published literature through the Internet,time limited from January 2005 to December 2017.Chinese database:CNKI,VIP,Wanfang database;English:Pubmed,Cochrane,library Springerlink,Elsevier Wiley,Online Library,Web Of Science.The two authors independently selected eligible papers and extracted relevant data.If any disputes arose,they were resolved via consultation or according to the senior researcher's discretion.The screened randomized controlled trials,case-control trialsand cohort studies of the literature included in the study,the rest abandoned.The screened randomized controlled trials,case-control trials and cohort studies of the literature included in the study,the rest abandoned.For the quality evaluation of the literature,the Cochrane RCT quality evaluation criteria were used for randomized controlled trials;cohort studies and case-control studies were conducted using the Newcastle-Ottawa Scale(NOS)to develop a literature quality evaluation criteria adapted to this study.The X~2 test was adopted to assess heterogeneity among the included research results,followed by a quantitative analysis of heterogeneity by I~2.When P<0.1 and/or I~2>50%,heterogeneity among the research results was indicated,and a random-effects model was subsequently adopted.Conversely,if P>0.1 and/or I~2<50%,a fixed-effects model was selected.In the presence of significant clinical heterogeneity,no combined analysis was performed.A95%confidence interval(CI)was computed for all statistics.Funnel plots were used to detect potential publication biases.The significance level was set to?=0.05.R 3.4.1software was adopted for independent and individual meta-analyses of the incidence of internal hernia.Results:A total of 19867 patients from the 20 selected papers were included.The final 20papersincluded19867patients.Therewas1high-qualityRCTand3less-than-mediumquality RCT papers.The remaining papers were less-than-medium-quality case-control studies or cohort studies with evidence levels ranging from2b to 3b.Eleven articles conformed to the complete mesenteric defects closure group.Of a total of 7556 patients,108 suffered from postoperative mesenteric hernia,reflecting a low incidence(2%,P<0.01,95%CI:0.01-0.03).The complete mesenteric defects closure group was subdivided into an RCT(randomized controlled trial)subgroup and a non-RCT subgroup for further analysis.Five articles conformed to the RCT complete mesenteric defects closure subgroup.Of a total of 1559 patients,32 suffered from postoperative mesenteric hernia,reflecting an incidence of 2%(P=0.02,95%CI:0.01-0.07).Seven articles conformed to the non-RCT complete mesenteric defects closure subgroup.Of all5997 patients,76 suffered from postoperative mesenteric hernia,reflecting an incidence of 1%(P=0.01,95%CI:0.01-0.02).Nine articles conformed to the jejunum-jejunal anastomotic mesenteric defects closure group.The incidence of postoperative mesenteric hernia was 4%.P<0.01 indicated that the difference was statistically significant(95%CI:0.02-0.06).Nine articles conformed to the no mesenteric defects closure group.The incidence of postoperative mesenteric hernia was 4%.P<0.01 demonstrated that the difference was statistically significant(95%CI:0.03-0.07).Conclusion:1.Close all mesentery defects in Roux-en-Y anastomosis before laparoscopic colon can effectively reduce the incidence of postoperative mesenteric hernia.2.The mesenteric defects were further confirmed as the main predisposing factors of postoperative mesenteric hernia.3.In future studies,high-quality randomized clinical trials should be designed to assess the actual effects of different mesenteric closure techniques on the incidence of postoperative hernia to achieve a consensus regarding the necessity of conventional mesenteric defects closure.