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Clinical characteristics and surgical outcomes of internal hernia after gastrectomy in gastric cancer patients: retrospective case control study

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Abstract

Background

Although the internal hernia is rare after gastric cancer surgery, it is a serious complication, and prompt surgical treatment is essential. However, internal hernia has not been studied because of low incidence and difficulty of diagnosis. This study investigated the clinical characteristics and proper management of internal hernia after gastrectomy.

Methods

From June 2001 to June 2016, patients who underwent gastrectomy, either open or laparoscopic (robotic) surgery, with potential internal hernia defect were enrolled. The hernia defect was not closed in any of the enrolled patients. The clinicopathological data of internal hernia patients were compared to patients without internal hernia to identify risk factors. Surgical outcomes of internal hernia were compared between patients who underwent early and late intervention group according to time interval from symptom onset to operation.

Results

Of 5777 patients who underwent gastrectomy with possible internal hernia, 24 (0.4%) underwent emergency or scheduled surgery for internal hernia. Internal hernia through the Petersen space was observed in 15 cases, and through the jejunojejunostomy mesenteric defect in 9 cases. Low body mass index (odds ratio [OR] 4.403, p = 0.003) and laparoscopic approach (OR 6.930 p < 0.001) were statistically significant factors in multivariate analysis. Postoperative complication rate (16.7% vs. 50% p = 0.083) and mortality rate (8.3% vs. 25.0% p = 0.273) were slightly higher in the late intervention group.

Conclusions

Although internal hernia is a rare complication, it is difficult to diagnose and cause serious complications. To prevent internal hernia, the necessity of hernia defect closure should be investigated in the further studies. Early surgical treatment is necessary when it is suspected.

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Acknowledgements

This work was supported by a grant (NCC 1710160-2) from the National Cancer Center, Republic of Korea.

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Authors and Affiliations

  1. Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea

    Won Ho Han, Bang Wool Eom, Hong Man Yoon, Young-Woo Kim & Keun Won Ryu

  2. Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea

    Keun Won Ryu

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  1. Won Ho Han
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Correspondence to Keun Won Ryu.

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Disclosures

Won Ho Han, Bang Wool Eom, Hong Man Yoon, Young-Woo Kim, Keun Won Ryu have no conflicts of interest or financial ties to disclose.

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Han, W.H., Eom, B.W., Yoon, H.M. et al. Clinical characteristics and surgical outcomes of internal hernia after gastrectomy in gastric cancer patients: retrospective case control study. Surg Endosc 33, 2873–2879 (2019). https://doi.org/10.1007/s00464-018-6584-3

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  • DOI: https://doi.org/10.1007/s00464-018-6584-3

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