Internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

Kimura, Hideyo; Ishikawa, Masakazu; Nabae, Toshinaga; Matsunaga, Taketo; Murakami, Soichiro; Kawamoto, Masahiko; Kamimura, Tetsuro; Uchiyama, Akihiko

doi:10.1016/j.asjsur.2015.09.003

Cited by 33 publications

(19 citation statements)

References 28 publications

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“…Laparoscopic surgery has advantages such as a decrease in post-operative pain, decrease in adhesion rates, better cosmetic results, earlier recovery, and lesser duration of hospitalization (1,7). Many studies have demonstrated that the long-term results of laparoscopic surgery and open surgery in gastric cancers were similar (5,8).…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for this situation include the decrease in mesenteric fat tissue because of postoperative weight loss, lesser amount of adhesions following laparoscopic surgery, leaving a longer Roux limb, and the . Internal herniation after laparoscopic gastric resection can be seen at any time after surgery, but the prevalence increases after the first year (1,4,5). In a study by Kelly et al (3), the authors stated that the rate of internal herniation following laparoscopic total gastrectomy was 22% at the end of an average of 22.4-month follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…It is significant to have early diagnosis and immediate intervention for treatment. Intestinal necrosis, which develops in the case of a delay, will lead to mortality and a significant morbidity like the short bowel syndrome (1,3). Tomographic evaluation is a diagnostic tool in the majority of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…The space between the meso of the Roux limb and the meso of the transverse colon is called Petersen's space (1). Almost half of the internal herniation cases are based on the occurrence of this space.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

“…Nevertheless, majority of patients that require bowel resection recover well according to various reports in the literature. Three cases of short gut syndrome and four cases of mortality have been reported 2 6 9. Depending of the location of internal hernia, a primary repair is usually performed for Petersen's defect, jejunojejunostomy mesenteric defect and transverse colon mesocolic defect with nonabsorbable sutures.…”

Section: Discussionmentioning

confidence: 99%

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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Retrocolic versus antecolic gastrointestinal reconstruction in robotic pancreaticoduodenectomy

Wang

Huang

Zhang

et al. 2019

J Hepato Biliary Pancreat

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Background With the advancement of robotic pancreaticoduodenectomy (RPD), several reconstruction methods have been advocated to make RPD more effective and safer. In this study, we investigated the safety and effectiveness of RPD using a left retrocolic (Lport) technique and compared it with those of RPD using an antecolic technique. Methods Between October 2015 and August 2016, we retrospectively reviewed consecutive cases of RPD before and after introducing the L-port technique for gastrointestinal reconstruction. The L-port technique was mainly performed for retrocolic gastrojejunal reconstruction and some cases of duodenojejunal reconstruction. The perioperative and postoperative outcomes were compared in the two groups. Results Eighty-three cases of RPD were retrieved for statistical analysis. Compared with the antecolic group, the L-port group was significantly associated with a shorter operative time (median time min vs. 390 [370-455] min, P < 0.001), reconstruction time (54 [48-59] min vs. 84 [75-98] min, P < 0.001) and lower incidence of delayed gastric emptying. There were no cases of re-operation due to internal herniation, colonic ischemia, or bowel volvulus in the L-port group during the 1-year follow-up period.Conclusions Our results demonstrated that the L-port technique of RPD is a safe and feasible technique for gastrointestinal reconstruction.

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Internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

Cited by 33 publications

References 28 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

Retrocolic versus antecolic gastrointestinal reconstruction in robotic pancreaticoduodenectomy

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