Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.

Hello everyone, this is Matt Martin. I'm a bariatric surgeon and acute care surgeon at the Los Angeles County USC Medical Center.

And we're here with the new behind-the-knife bariatric surgery team to talk about a couple of articles, so I'll have the rest of the team introduce themselves.

Hey, Vincent Chang, I just finished my bariatric surgery fellowship at Kaiser South Sacramento, and I will be working at Kaiser Ontario for bariatric surgery as well.

Hi, my name is Norjane Spangler. I'm a general bariatric surgeon at Duke University, where I'm also the fellowship director for our advanced GIMIS and bariatric surgery fellowships, where we have three clinical fellows every year.

Hi, my name is Adrian Dan, and I am also a bariatric foreguard in my surgeon. I work at Summa Health in Akron, Ohio, where I'm also the program director for our fellowship and advanced GIMIS, where I got in bariatric surgery, and I'm also associate professor of surgery with Northeast Ohio Medical University.

Today, we'll be discussing a paper written by Stemberg, published in 2023 title, Law Term Safety and Ethics C of Supposure of Mizzontaric Defects in Lappestopic Graphic Bypass Surgery.

But before we jump into the paper, I wanted to ask our attendings whether they close the Bessertaric Defects below the Diagnostomy, or at Peterson's Defect.

I close both defects 100% of the time with non-absorbable suture.

I do either a purse string or a running closure or a combination of both depending on the shape and structure of the defect itself.

I also close both defects routinely on gastric bypass procedures. I like to use permanent braided suture, placed in a figure-a-weighted fashion to bring the Mizzontaric edges together.

The only exceptions are situations where the operating surgeon has considered closure and attempted it, but it may feel that it could lead to bleeding or tearing of a heavy mesenteria or something detrimental.

Otherwise, it always gets closed.

Yeah, and I previously closed both defects, and then when we adjusted our technique for bypass, I went to just closure of the defect at the Geginogenostomy and not closing Peterson's.

What are you doing in your fellowship and plan in your practice, Vince?

But we close both defects with running non-absorbable suture, and that's what I plan on doing as an attendings as well.

But I do understand that there is some variability in closure methods.

Ayo-yo, some people use interrupted sutures, some people use permanent and I'm used absorbable. There's various techniques using clips.

I've seen one group that went to just scratching those areas with a bovee pad and assuming that adhesions would form.

Note no good data on that technique, but there are multiple methods to close both of these defects, and obviously that also compromises any literature on the topic.

Let me ask you what some of the downsides of closing the defects are.

As mentioned in this paper, it's been suggested that there might be an increase in the risk of chronic abdominal pain with closure of the defects, although I'd say that is not definitive.

...