Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.
The aim of this study was to assess the efficacy of prophylactic drain placement in laparoscopic total gastrectomy (LTG). Ninety-four patients with gastric cancer who underwent LTG between December 2007 and December 2014 were enrolled in this study. A tube drain was placed in 29 patients after considering it necessary by operators, whereas no tube drain was placed in remaining patients. All patients were classified into either the drain or the no-drain group and were investigated for clinical characteristics and surgical outcomes. Overall, complications occurred in 15 patients and were not significantly different between the drain and no-drain groups [5 (17.2%) versus 10 (15.4%) patients]. No significant difference was observed in median duration of postoperative hospital stay between the drain and no-drain groups (12 versus 12 days). There was no significant difference in the duration of hospital stay regardless of the presence of drains in both groups of patients who developed complications (with drain: 27 days versus without drain: 21.5 days) and those who did not develop complications (with drain: 12 days versus without drain: 12 days). In conclusion, on the basis of the results of this study, routine prophylactic drain placement in LTG may not be necessary because it does not offer any additional benefits for patients.
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