Abstract
Although internal hernia (IH) has been reported after laparoscopic distal or total gastrectomy with Roux-en-Y reconstruction, there are few reports of IH after proximal gastrectomy with jejunal interposition (PG-JI). The aim of this study was to analyze the incidence and clinical features of IH after PG-JI. This study retrospectively reviewed 71 patients who underwent PG-JI for gastric cancer at a single institution between July 2007 and December 2016. The median follow-up period after PG-JI was 50 months. Four patients (5.6%) developed IH. IH occurred in 3 of 38 patients after open PG (7.9%) and 1 of 33 after laparoscopic PG (3.1%; p = 0.38). The site of IH was Petersen in all cases, where the Petersen defect was not closed. All patients had abdominal pain at onset, and the CT revealed a whirl sign. Bowel resection was required in three patients (75%). There was no morbidity. IH after PG-JI occurred regardless of operative approach (open or laparoscopic). A high degree of suspicion for IH should be maintained in patients after gastrectomy with abdominal pain and a whirl sign on CT. Closure of the mesenteric defects should be considered to reduce the incidence of IH after surgery.
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References
Paroz A, Calmes JM, Giusti V, Suter M (2006) Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg 16:1482–1487
Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247:962–967
Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T, Kimura Y, Fujiwara Y, Mori M, Doki Y (2012) Recent trend of internal hernia occurrence after gastrectomy for gastric cancer. World J Surg 36:851–857
Kojima K, Inokuchi M, Kato K, Motoyama K, Sugihara K (2014) Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer. Gastric Cancer 17:146–151
Hosoya Y, Lefor A, Ui T, Haruta H, Kurashina K, Saito S, Zuiki T, Sata N, Yasuda Y (2011) Internal hernia after laparoscopic gastric resection with antecolic Roux-en-Y reconstruction for gastric cancer. Surg Endosc 25:3400–3404
Hirashima K, Ishikawa T, Kosugi S, Kano Y, Sato Y, Ichikawa H, Hanyu T, Bamba T, Wakai T (2015) Internal hernia after laparoscopic-assisted proximal gastrectomy with jejunal interposition for gastric cancer: a case report. Surg Case Rep 1:49
Japanese Gastric Cancer A (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112
Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458
Campanile FC, Boru CE, Rizzello M, Puzziello A, Copaescu C, Cavallaro G, Silecchia G (2013) Acute complications after laparoscopic bariatric procedures: update for the general surgeon. Langenbecks Arch Surg 398:669–686
Escalona A, Devaud N, Perez G, Crovari F, Boza C, Viviani P, Ibanez L, Guzman S (2007) Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis 3:423–427
Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S, Watanabe R, Tanimura S, Sano T, Kitagawa Y, Yamaguchi T (2011) Different features of complications with Billroth-I and Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy. J Gastrointest Surg 15:2145–2152
Kimura H, Ishikawa M, Nabae T, Matsunaga T, Murakami S, Kawamoto M, Kamimura T, Uchiyama A (2015) Internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer. Asian J Surg 40:203–209
Kelly KJ, Allen PJ, Brennan MF, Gollub MJ, Coit DG, Strong VE (2013) Internal hernia after gastrectomy for cancer with Roux-Y reconstruction. Surgery 154:305–311
Yoshikawa K, Shimada M, Kurita N, Sato H, Iwata T, Higashijima J, Chikakiyo M, Nishi M, Kashihara H, Takasu C, Matsumoto N, Eto S (2014) Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Surg Endosc 28:1774–1778
Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A (2005) Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 19:34–39
Miyato H, Kitayama J, Hidemura A, Ishigami H, Kaisaki S, Nagawa H (2012) Vagus nerve preservation selectively restores visceral fat volume in patients with early gastric cancer who underwent gastrectomy. J Surg Res 173:60–67
Bauman RW, Pirrello JR (2009) Internal hernia at Petersen’s space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure–a single surgeon series of 1047 cases. Surg Obes Relat Dis 5:565–570
Hirahara N, Matsubara T, Hayashi H, Takai K, Fujii Y, Tajima Y (2015) Easy and secure closure of petersen’s defect after laparoscopic distal gastrectomy with Roux-en-Y reconstruction. J Laparoendosc Adv Surg Tech A 25:55–59
Lockhart ME, Tessler FN, Canon CL, Smith JK, Larrison MC, Fineberg NS, Roy BP, Clements RH (2007) Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR 188:745–750
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Takayama, Y., Kaneoka, Y., Maeda, A. et al. Internal hernia after proximal gastrectomy with jejunal interposition. Updates Surg 70, 85–90 (2018). https://doi.org/10.1007/s13304-017-0497-x
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DOI: https://doi.org/10.1007/s13304-017-0497-x