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Recent Trend of Internal Hernia Occurrence After Gastrectomy for Gastric Cancer

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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/m2) 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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Acknowledgments

This study was conducted without any financial support. The authors thank all participants of the Osaka University Clinical Research Group for Gastroenterological Surgery. The following is a list of the 24 high-volume centers in Kinki area that participated in this study: National Hospital Organization Osaka National Hospital, Osaka; Toyonaka Municipal Hospital, Osaka; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Kansai Rosai Hospital, Hyogo; Osaka Police Hospital, Osaka; Osaka University Hospital, Osaka; Osaka General Medical Center, Osaka; Osaka Rosai Hospital, Osaka; Osaka Koseinenkin Hospital, Osaka; Nara Hospital Kinki University Faculty of Medicine, Nara; NTT West Osaka Hospital, Osaka; Higashiosaka City General Hospital, Osaka; Hyogo Prefectural Nishinomiya Hospital, Hyogo; Ikeda City Hospital, Osaka; Otemae Hospital, Osaka; Itami City Hospital, Hyogo; Bell Land General Hospital, Osaka; Moriguchi Keijinkai Hospital, Osaka; Social Insurance Kinan Hospital, Wakayama; Yao Municipal Hospital, Osaka; Kinki Central Hospital, Hyogo; Suita Municipal Hospital, Osaka; Minoh City Hospital, Osaka; Saiseikai Senri Hospital, Osaka, Japan.

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Authors and Affiliations

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

    Hiromichi Miyagaki, Shuji Takiguchi, Yukinori Kurokawa, Yoshiyuki Fujiwara, Masaki Mori & Yuichiro Doki

  2. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Motohiro Hirao

  3. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan

    Shigeyuki Tamura

  4. Department of Surgery, Osaka Police Hospital, Osaka, Japan

    Toshirou Nishida

  5. Department of Gastroenterological Surgery, NTT West Hospital, Osaka, Japan

    Yutaka Kimura

Authors
  1. Hiromichi Miyagaki
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  2. Shuji Takiguchi
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  3. Yukinori Kurokawa
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  4. Motohiro Hirao
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  5. Shigeyuki Tamura
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  6. Toshirou Nishida
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  7. Yutaka Kimura
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  8. Yoshiyuki Fujiwara
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  9. Masaki Mori
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  10. Yuichiro Doki
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Correspondence to Shuji Takiguchi.

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Miyagaki, H., Takiguchi, S., Kurokawa, Y. et al. Recent Trend of Internal Hernia Occurrence After Gastrectomy for Gastric Cancer. World J Surg 36, 851–857 (2012). https://doi.org/10.1007/s00268-012-1479-2

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  • DOI: https://doi.org/10.1007/s00268-012-1479-2

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