Background
The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and risk factors for internal hernia after gastrectomy for gastric cancer.
Methods
We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors.
Results
Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7%) and the median interval time was 450 days after gastrectomy. Fourteen (0.9%) of the 1510 patients who underwent open gastrectomy and 97 (2.0%) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0%), 9 (1.1%), 40 (3.1%), 56 (3.3%), 6 (2.3%), and 0 (0%) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2%) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2%), 27 (45.8%), and 0 (0%) were identified in jejunojejunostomy mesenteric, Petersen’s, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (
P
< 0.01), laparoscopic approach (
P
< 0.01), and totally laparoscopic approach (
P
= 0.03) were independent risk factors for internal hernia.
Conclusions
The potential spaces such as Petersen’s, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.
Purpose
There is no consensus on the optimal method for intracorporeal esophagojejunostomy (EJ) in laparoscopic total gastrectomy (LTG). This study aims to compare 2 established methods of EJ anastomosis in LTG.
Materials and Methods
A total of 314 patients diagnosed with gastric cancer that underwent LTG in the period from January 2013 to October 2016 were enrolled in the study. In 254 patients, the circular stapler with purse-string “Lap-Jack” method was used, and in the other 60 patients the linear stapling method was used for EJ anastomosis. After propensity score matching, 58 were matched 1:1, and retrospective data for patient characteristics, surgical outcome, and post-operative complications was reviewed.
Results
The 2 groups showed no significant difference in age, body mass index, or other clinicopathological characteristics. After propensity score matching analysis, the linear group had shorter operating time than the circular group (200.3±62.0 vs. 244.0±65.5, P≤0.001). Early postoperative complications in the circular and linear groups occurred in 12 (20.7%) and 15 (25.9%, P=0.660) patients, respectively. EJ leakage occurred in 3 (5.2%) patients from each group, with 1 patient from each group needing intervention of Clavien-Dindo grade III or more. Late complications were observed in 3 (5.1%) patients from the linear group only, including 1 EJ anastomosis stricture, but there was no statistical significance.
Conclusions
Both circular and linear stapling techniques are feasible and safe in performing intracorporeal EJ anastomosis during LTG. The linear group had shorter operative time, but there was no difference in anastomosis complications.
Primary aortic angiosarcoma is very rare, and preoperative diagnosis is challenging with resultant poor prognosis. Angiosarcoma may mimic an infected aneurysm or a mural thrombus. Clinical suspicion of angiosarcoma is vital for an early diagnosis and proper surgical treatment, especially in cases with atypical rapid growth of an aortic abdominal aneurysm with a thrombotic mass. Herein, we report a case of angiosarcoma in the abdominal aorta mimicking an infected aneurysm and present computed tomography and positron emission tomography findings.
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