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Recent trend of internal hernia occurrence after gastrectomy for gastric cancer.

Abstract

BACKGROUND
The incidence of internal hernia after gastrectomy can increase with the increasing use of laparoscopic surgery, although this trend has not been elucidated.
METHODS
Clinical information was collected from medical records and by questionnaire for 18 patients who underwent surgical treatment for internal hernia after gastrectomy for gastric cancer in 24 hospitals from January 2005 to December 2009.
RESULTS
Gastrectomy for gastric cancer was open/distal gastrectomy (DG) in five (28%) patients, open/total gastrectomy (TG) in seven (39%), laparoscopy-assisted/DG in three (17%), and laparoscopy-assisted/TG in 3 (17%). Reconstruction was by Roux-Y methods in all patients. The hernia orifice was classified as a jejunojejunostomy mesenteric defect in eight patients (44%), dorsum of the Roux limb (Petersen's space) in eight (44%), and one (5%) each of esophageal hiatus and mesenterium of the transverse colon. Among 8,983 patients who underwent gastrectomy for gastric cancer, a postoperative survey revealed that 13 patients underwent surgical treatment for internal hernia in the same hospitals. The 3-year incidence rate of the internal hernia was 0.19%, which was significantly higher after laparoscopy-assisted than open gastrectomy (0.53 vs. 0.15%, p = 0.03). Patients with an internal hernia had a mean (±SD) low weight at hernia operation (body mass index 17.9 ± 1.6 kg/m(2)) and marked weight loss after gastrectomy (weight reduction 15.6 ± 5.8%).
CONCLUSIONS
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.

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    • Authors

    Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T, Kimura Y, Fujiwara Y, Mori M, Doki Y

    Institution

    Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.

    Source

    World journal of surgery 36:4 2012 Apr pg 851-7

    MeSH

    Aged
    Aged, 80 and over
    Anastomosis, Roux-en-Y
    Female
    Gastrectomy
    Hernia
    Herniorrhaphy
    Humans
    Incidence
    Laparoscopy
    Male
    Middle Aged
    Risk Factors
    Stomach Neoplasms

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22350485