Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer

  • Tetsuro Toriumi
  • Rie Makuuchi
  • Satoshi Kamiya
  • Yutaka Tanizawa
  • Etsuro Bando
  • Masanori TerashimaEmail author



Internal hernia (IH) is a life-threatening complication after gastrectomy. The increase in the frequency of minimally invasive surgery is considered to be related to the increase in the frequency of IH, and mesenteric defect closure has been recommended to reduce this complication. However, IH can occur even when mesenteric defects are closed, so the risk of IH in the patients with mesenteric closure remains uncertain. We attempted to clarify the risk factors for IH in these patients.


From 2013 to 2017, we retrospectively reviewed 310 patients with gastric cancer who underwent laparoscopic or robot-assisted gastrectomy with Roux-en-Y (RY) or double-tract (DT) reconstruction with mesenteric defect closure. Univariate and multivariate analyses were performed to identify the risk factors.


The incidence of IH was 1.3% (n = 4). A preoperative body mass index (BMI) ≥ 25 kg/m2 (p = 0.044), postoperative chemotherapy (p = 0.034), and body weight loss rate at 6 months ≥ 15% (p = 0.045) were risk factors for IH on a univariate analysis. A multivariate analysis showed that a BMI at the time of surgery of ≥ 25 kg/m2 was an independent risk factor for IH (odds ratio = 11.9, p = 0.049).


Preoperative obesity is an independent risk factor for IH after minimally invasive gastrectomy followed by RY or DT reconstruction with mesenteric defect closure. We need to conduct vigilant follow-up for IH, especially in these patients.


Internal hernia Gastric cancer Laparoscopic gastrectomy Robot-assisted gastrectomy Risk factor 



Not applicable.


We did not receive any financial support from any institutions.

Compliance with ethical standards


Tetsuro Toriumi, Rie Makuuchi, Satoshi Kamiya, Yutaka Tanizawa, Etsuro Bando, and Masanori Terashima have no conflict of interest or financial ties to disclose.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan

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