Recent Trend of Internal Hernia Occurrence After Gastrectomy for Gastric Cancer

Miyagaki, Hiromichi; Takiguchi, Shuji; Kurokawa, Yukinori; Hirao, Motohiro; Tamura, Shigeyuki; Nishida, Toshirou; Kimura, Yutaka; Fujiwara, Yoshiyuki; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s00268-012-1479-2

Cited by 61 publications

(68 citation statements)

References 49 publications

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“…Miyagaki et al [12] reported the reduction (13.5 %) after distal gastrectomy in their study was larger than in other studies (range, 9.1-10.5 %). In our study, the reduction after distal gastrectomy was 11.4 % on average (data not shown), which was also slightly larger than in other studies [13,14].…”

Section: Resultscontrasting

confidence: 49%

“…In the recent widespread use of laparoscopic surgery for gastric cancer, we should be aware of internal hernia after distal gastrectomy. However, there are only a few reports on the incidence of internal hernia, especially Petersen's hernia, with R-Y reconstruction after laparoscopic distal gastrectomy for cancer [11,12]. This is a matter of concern because these hernias can present dramatically as an acute bowel obstruction with necrosis of the bowel, especially when diagnosis with prompt surgical intervention is delayed [9].…”

Section: Introductionmentioning

confidence: 99%

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Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

et al. 2013

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Background To decrease the incidence of internal hernia after laparoscopic Roux-en-Y gastric bypass, recent recommendations indicated closure of mesenteric defects and Petersen's defect. Laparoscopic distal gastrectomy for gastric cancer is used increasingly, so the incidence of Petersen's hernia can also increase, but the trend has not been studied. Methods This study retrospectively reviewed 358 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer at one institution, with antecolic Roux-en-Y (RY) reconstruction. Results Petersen's hernia occurred in 6 (2.2 %) of 268 patients whose Petersen's defect was not closed by a mean of 351 days after surgery. All the patients underwent reoperation with reduction and repair of the hernia except the first case. In 90 subsequent cases, with closure of the Petersen's defect, internal hernias did not occur (0/90 cases; p = 0.06). Focusing on the totally laparoscopic procedure, Petersen's hernia occurred in 2 (5.1 %) of 39 patients, whereas in 81 subsequent cases, with closure of Petersen's defect, internal hernias did not occur (0/81 cases; p = 0.03). Conclusions Based on the recent recommendations for bariatric surgery, closure of this potential hernia defect is necessary after laparoscopic distal gastrectomy with R-Y reconstruction for gastric cancer.

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Section: Resultscontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

et al. 2013

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“…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%

“…Following Roux-en-Y reconstruction, Petersen's spaces, jejuna-jejunal spaces, and transverse mesocolon spaces (if anastomosis was performed retrocolic) was formed. The herniation of intestinal structures through such spaces may lead to intestinal obstruction, ischemia, or necrosis (3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

“…Almost half of the internal herniation cases are based on the occurrence of this space. Herniation cases can be prevented by closing the Petersen's and jejuna-jejunal spaces (4)(5)(6). 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.…”

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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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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Recent Trend of Internal Hernia Occurrence After Gastrectomy for Gastric Cancer

Abstract: Gastrectomy with Roux-Y reconstruction for gastric cancer leaves several spaces that can cause internal hernia formation. Laparoscopic surgery and postoperative body weight loss are potential risk factors.

Cited by 61 publications

References 49 publications

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

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