Internal Hernia After Proximal Gastrectomy with Jejunal Interposition

Overview

Journal Updates Surg

Specialty General Surgery

Date 2017 Nov 6

PMID 29103209

Citations 3

Authors

Yuichi Takayama

Yuji Kaneoka

Atsuyuki Maeda

Yasuyuki Fukami

Takamasa Takahashi

Shunsuke Onoe

Masahito Uji

Affiliations

Soon will be listed here.

Abstract

Although internal hernia (IH) has been reported after laparoscopic distal or total gastrectomy with Roux-en-Y reconstruction, there are few reports of IH after proximal gastrectomy with jejunal interposition (PG-JI). The aim of this study was to analyze the incidence and clinical features of IH after PG-JI. This study retrospectively reviewed 71 patients who underwent PG-JI for gastric cancer at a single institution between July 2007 and December 2016. The median follow-up period after PG-JI was 50 months. Four patients (5.6%) developed IH. IH occurred in 3 of 38 patients after open PG (7.9%) and 1 of 33 after laparoscopic PG (3.1%; p = 0.38). The site of IH was Petersen in all cases, where the Petersen defect was not closed. All patients had abdominal pain at onset, and the CT revealed a whirl sign. Bowel resection was required in three patients (75%). There was no morbidity. IH after PG-JI occurred regardless of operative approach (open or laparoscopic). A high degree of suspicion for IH should be maintained in patients after gastrectomy with abdominal pain and a whirl sign on CT. Closure of the mesenteric defects should be considered to reduce the incidence of IH after surgery.

Citing Articles

Digestive tract reconstruction after laparoscopic proximal gastrectomy for Gastric cancer: A systematic review.

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Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer.

Toriumi T, Makuuchi R, Kamiya S, Tanizawa Y, Bando E, Terashima M Surg Endosc. 2019; 34(1):436-442.

PMID: 30963263 DOI: 10.1007/s00464-019-06787-x.

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