Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer

Yoshikawa, Kozo; Shimada, Mitsuo; Kurita, Nobuhiro; Sato, Hirohiko; Iwata, Takashi; Higashijima, Jun; Chikakiyo, Motoya; Nishi, Masaaki; Kashihara, Hideya; Takasu, Chie; Matsumoto, Noriko; Eto, Syohei

doi:10.1007/s00464-013-3384-7

Cited by 36 publications

(33 citation statements)

References 22 publications

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“…Tomographic evaluation is a diagnostic tool in the majority of the cases. Mesenteric torsion and the related stopping of vascular flow, dilated intestinal loops, and acid and dilatation in the biliopancreatic segment are among the findings observed by tomography (5,8). In our case, air images were also observed in the portal system in addition to these findings.…”

Section: Discussionsupporting

confidence: 71%

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Mortality due to Internal Herniation As A Late Complication in A Patient who Underwent Laparoscopic Total Gastrectomy for Early Gastric Cancer

Aday¹,

Çiyiltepe²,

Çetin³

et al. 2016

Bezmialem Science

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Potential spaces predisposing to internal hernias in the abdomen occurs after laparoscopic gastrectomy with Roux-en-Y reconstruction. Closure of potential spaces in primary surgery and early surgical treatment after herniation suspicion is important because of the high risk of morbidity and mortality. We hereby present the case of a patient who underwent laparoscopic total gastrectomy because of early-phase gastric cancer and who developed massive intestinal necrosis because of internal herniation in the third year of follow-up. A 60-year-old male underwent an urgent laparotomy, and ischemia in the cecum and all throughout the small intestine was observed because of small intestine herniation between the Roux limb and the meso of the transverse colon after laparoscopic gastrectomy for early gastric cancer. Following the detorsion of all the small intestinal segments, it was seen that the flow in the main branches of the superior mesenteric artery regained activity, but no significant change in coloring was achieved in the distal segments and the cecum. The patient, for whom relaparotomy was planned following stabilization, died in the fourth post-operative hour. The Roux-en-Y reconstruction performed after laparoscopic gastric resection leads to the formation of novel spaces in the abdomen. Internal herniation, which can lead to mortality, can be prevented by closing these spaces up. Moreover, it is significant to have early diagnosis and perform the necessary surgical procedure for treatment without delay. Keywords: Internal herniation, laparoscopy, gastric cancer, Petersen's space ÖZLaparaskopik gastrektomi sonrası Roux-en-Y rekonstrüksiyonu, batın içerisinde internal herniasyona zemin hazırlayan boşluk-ların oluşumu ile sonuçlanır.Yüksek mortalite ve morbiditeye neden olması nedeniyle, oluşturulan açıklıkların kapatılması, herniasyonun geliştiği durumlarda tedaviye yönelik girişimlerin gecikmeden yapılması önemlidir. Erken evre mide kanseri nedeniyle laparaskopik total gastrektomi yapılan ve takibinin üçüncü yılında internal herniasyon nedeniyle masif intestinal nekroz gelişen olgu sunulmuştur. Altmış yaşında erkek hasta, akut karın nedeniyle yapılan laparatomide, internal herniasyona bağlı total ince barsak ve sağ kolon nekrozu saptanmıştır. Daha önceden erken ever mide kanseri nedeniyle, laparoskopik total gastrektomi ile Roux-en-Y özofagojejunostomi yapılan hastanın, herniasyonun Roux bacağı mezosunun dorsalinden geliştiği izlendi. Detorsiyona rağmen barsak beslenmesinde düzeltme olmayan hasta, cerrahi sonrası erken dönemde kaybedildi. Laparaskopik mide rezeksiyonu sonrası Roux-en-Y rekostrüksiyonu, batın içe-risinde yeni açıklıkların oluşumu ile sonuçlanır. Bu açıklıkların kapatılması ile mortalite ile sonuçlanabilen internal herniasyon önlenebilir. Erken tanı ve tedaviye yönelik cerrahinin zaman kaybetmeden yapılması çok önemlidir.Anahtar Kelimeler: Internal herniasyon, laparaskopi, mide kanseri, petersen boşluğu

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Section: Discussionsupporting

confidence: 71%

“…Many studies have demonstrated that the long-term results of laparoscopic surgery and open surgery in gastric cancers were similar (5,8). Roux-en-Y reconstruction is frequently preferred because of its prevention of anastomotic leaks and reflux in laparoscopic total or subtotal gastrectomy (9).…”

Section: Discussionmentioning

confidence: 99%

Mortality due to Internal Herniation As A Late Complication in A Patient who Underwent Laparoscopic Total Gastrectomy for Early Gastric Cancer

Aday¹,

Çiyiltepe²,

Çetin³

et al. 2016

Bezmialem Science

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show abstract

“…The incidence is thought to be <0.1%. Several studies have also reported higher incidence of internal hernia in the laparoscopic group than in the open group 1 3 9. As the incidence of gastric cancer is significantly lower in the western demographics, laparoscopic gastrectomies are infrequently performed and therefore there is less experience dealing with potential complications such as internal hernia.…”

Section: Discussionmentioning

confidence: 99%

“…A few potential risk factors are found to be associated with the occurrence of internal hernia: (1) laparoscopic surgery reduces the formation of adhesions due to less handling of bowels, (2) weight loss as a result of the surgery reduces the mesenteric fat and accelerates the increase of the size of the mesenteric defect,6 (3) men are more likely to have internal hernia and (4) retrocolic limb Roux-en-Y reconstruction is associated with higher incidence of internal hernia than antecolic limb in a few series 3. Internal hernia secondary to retrocolic technique is associated with higher rates of bowel resections 3…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, patients may provide a history of intermittent abdominal pain that maybe due to interval herniation that spontaneously reduces. On clinical examination, findings of tachycardia and fever should raise suspicious of bowel compromise 3. Biochemistry examination maybe unremarkable until late progression in which leucocytosis, raised C reactive protein and lactate levels would be observed.…”

Section: Discussionmentioning

confidence: 99%

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Dual incarcerated internal hernias after laparoscopic total gastrectomy with Roux-en-Y reconstruction for gastric cancer

Ng¹,

Low

Subramanian

et al. 2017

BMJ Case Reports

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Internal hernia postgastrectomy is an exceedingly rare complication especially in the laparoscopic cohort of patients. Different types of internal hernias have been described, of which, Petersen's and jejunojejunostomy mesenteric defect hernias are the most commonly encountered followed by oesophageal defect and transverse colon mesocolic defect hernias. As the early presentation is always non-specific, late diagnosis of internal hernia has significant implication on morbidity and mortality. Here, we present a rare case of a patient with previous laparoscopy-assisted total gastrectomy presented with features of impending bowel obstruction and bowel ischaemia secondary to dual incarcerated internal hernias. We also reviewed the literature focusing on clinical features of internal hernia, essential CT findings and preventive measures.

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Association between the antiadhesion membrane and small bowel obstruction after open gastrectomy: A supplemental analysis of the randomized controlled JCOG1001 trial

Toriumi

Terashima

Mizusawa

et al. 2023

Annals of Gastroent Surgery

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AimPostoperative small bowel obstruction (SBO) is one of the major complications that is mainly caused by postoperative adhesion. Recently, the antiadhesion membrane has become popular for postoperative SBO prevention. However, its efficacy is yet to be confirmed in the gastric cancer surgery field. Here, we conducted the supplemental analysis of the randomized controlled trial JCOG1001 to investigate the efficacy of the antiadhesion membrane on SBO prevention in patients with open gastrectomy for gastric cancer.MethodsOf the 1204 patients enrolled in JCOG1001, 1200 patients were included. The development of SBO of Grade ≥ IIIa according to the Clavien–Dindo classification was recorded. Univariable and multivariable analyses were performed using the Fine and Gray model to determine the risk factors for SBO.ResultsFifty‐one patients developed SBO (median follow‐up duration: 5.6 years). Total gastrectomy, combined resection, and blood loss significantly increased the risk for SBO development in the univariable analysis. Large amount of blood loss was independently associated with SBO development in the multivariable analysis (hazard ratio [HR], 3.089; 95% confidence interval [CI], 1.562–6.109, p = 0.0012). Antiadhesion membrane did not reduce the risk for SBO (HR, 1.299; 95% CI 0.683–2.470; p = 0.4246). In the patients belonging to subgroup analyses who received distal and total gastrectomy, the antiadhesion membrane was not associated with the incidence of SBO.ConclusionsAntiadhesion membrane did not decrease SBO occurrence rate after open gastrectomy. Therefore, the use of antiadhesion membrane would not be effective for preventing SBO in gastric cancer surgery.

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Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer

Abstract: The present data suggest the importance of early recognition and treatment of internal hernia, as well as its prevention by closure of mesenteric defects.

Cited by 36 publications

References 22 publications

Mortality due to Internal Herniation As A Late Complication in A Patient who Underwent Laparoscopic Total Gastrectomy for Early Gastric Cancer

Mortality due to Internal Herniation As A Late Complication in A Patient who Underwent Laparoscopic Total Gastrectomy for Early Gastric Cancer

Dual incarcerated internal hernias after laparoscopic total gastrectomy with Roux-en-Y reconstruction for gastric cancer

Association between the antiadhesion membrane and small bowel obstruction after open gastrectomy: A supplemental analysis of the randomized controlled JCOG1001 trial

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