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Mesenteric closure after laparoscopic total gastrectomy with Roux-en-Y reconstruction is effective for prevention of internal hernia: a multicenter retrospective study

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Abstract

Background

Internal hernia (IH) is one of the critical complications after gastrectomy with Roux-en-Y reconstruction, which can be prevented by closing mesenteric defects. However, only few studies have investigated the incidence of IH after laparoscopic total gastrectomy (LTG) with Roux-en-Y reconstruction for gastric cancer till date. This study aimed to assess the efficacy of defect closure for the prevention of IH after LTG.

Methods

This multicenter, retrospective cohort study collected data from 714 gastric cancer patients who underwent LTG with Rou-en-Y reconstruction between 2010 and 2016 in 13 hospitals. We evaluated the incidence of postoperative IH by comparing closure and non-closure groups of Petersen’s defect, jejunojejunostomy mesenteric defect, and transverse mesenteric defect.

Results

The closure group for Petersen’s defect included 609 cases, while the non-closure group included 105 cases. The incidence of postoperative IH in the closure group for Petersen’s defect was significantly lower than it was in the non-closure group (0.5% vs. 4.8%, p < 0.001). The closure group for jejunojejunostomy mesenteric defect included 641 cases, while the non-closure group included 73 cases. The incidence of postoperative IH in the closure group of jejunojejunostomy mesenteric defect was significantly lower than that in the non-closure group (0.8% vs. 4.1%, p = 0.004). Out of 714 patients, 41 underwent retro-colic reconstruction. No patients in the transverse mesenteric defect group developed IH.

Conclusion

Mesenteric defect closure after LTG with Roux-en-Y reconstruction may reduce postoperative IH incidence. Endoscopic surgeons should take great care to prevent IH by closing mesenteric defects.

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Funding

Operating support grants from Kyoto University supported this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Katsuhiro Murakami, Kazutaka Obama, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori & Yoshiharu Sakai

  2. Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan

    Seiichiro Kanaya

  3. Department of Gastroenterological Surgery and Oncology, Himeji Medical Center, Himeji, Japan

    Seiji Satoh

  4. Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan

    Dai Manaka

  5. Department of Surgery, Shiga General Hospital, Moriyama, Japan

    Michihiro Yamamoto

  6. Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan

    Yoshio Kadokawa

  7. Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan

    Atsushi Itami

  8. Department of Surgery, Otsu City Hospital, Otsu, Japan

    Hiroshi Okabe

  9. Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Hiroaki Hata

  10. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan

    Eiji Tanaka

  11. Department of Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan

    Yoshito Yamashita

  12. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Masato Kondo

  13. Department of Surgery, Kyoto City Hospital, Kyoto, Japan

    Hisahiro Hosogi

  14. Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan

    Katsuhiro Murakami, Kazutaka Obama, Seiichiro Kanaya, Seiji Satoh, Dai Manaka, Michihiro Yamamoto, Yoshio Kadokawa, Atsushi Itami, Hiroshi Okabe, Hiroaki Hata, Eiji Tanaka, Yoshito Yamashita, Masato Kondo, Hisahiro Hosogi, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori & Yoshiharu Sakai

Authors
  1. Katsuhiro Murakami
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  2. Kazutaka Obama
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  3. Seiichiro Kanaya
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  15. Shigeru Tsunoda
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  16. Shigeo Hisamori
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  18. Yoshiharu Sakai
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Corresponding author

Correspondence to Kazutaka Obama.

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Disclosures

Drs. Katsuhiro Murakami, Kazutaka Obama, Seiichiro Kanaya, Seiji Satoh, Dai Manaka, Michihiro Yamamoto, Yoshio Kadokawa, Atsushi Itami, Hiroshi Okabe, Hiroaki Hata, Eiji Tanaka, Yoshito Yamashita, Masato Kondo, Hisahiro Hosogi, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori, and Yoshiharu Sakai have no conflicts of interest or financial ties to disclose.

Ethical approval

The Kyoto University ethics committee and all the hospitals involved approved this multicenter, retrospective, comparative study (R1276). This study was conducted in accordance with the Declaration of Helsinki.

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This paper was based on a previous communication to the 91st Annual Meeting of the Japanese Gastric Cancer Association.

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Murakami, K., Obama, K., Kanaya, S. et al. Mesenteric closure after laparoscopic total gastrectomy with Roux-en-Y reconstruction is effective for prevention of internal hernia: a multicenter retrospective study. Surg Endosc 36, 4181–4188 (2022). https://doi.org/10.1007/s00464-021-08744-z

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