Abstract
Background
Internal hernia (IH) is a life-threatening complication after gastrectomy. The increase in the frequency of minimally invasive surgery is considered to be related to the increase in the frequency of IH, and mesenteric defect closure has been recommended to reduce this complication. However, IH can occur even when mesenteric defects are closed, so the risk of IH in the patients with mesenteric closure remains uncertain. We attempted to clarify the risk factors for IH in these patients.
Methods
From 2013 to 2017, we retrospectively reviewed 310 patients with gastric cancer who underwent laparoscopic or robot-assisted gastrectomy with Roux-en-Y (RY) or double-tract (DT) reconstruction with mesenteric defect closure. Univariate and multivariate analyses were performed to identify the risk factors.
Results
The incidence of IH was 1.3% (n = 4). A preoperative body mass index (BMI) ≥ 25 kg/m2 (p = 0.044), postoperative chemotherapy (p = 0.034), and body weight loss rate at 6 months ≥ 15% (p = 0.045) were risk factors for IH on a univariate analysis. A multivariate analysis showed that a BMI at the time of surgery of ≥ 25 kg/m2 was an independent risk factor for IH (odds ratio = 11.9, p = 0.049).
Conclusions
Preoperative obesity is an independent risk factor for IH after minimally invasive gastrectomy followed by RY or DT reconstruction with mesenteric defect closure. We need to conduct vigilant follow-up for IH, especially in these patients.
Similar content being viewed by others
References
Hori M, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, Japan Cancer Surveillance Research Group (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 45(9):884–891
Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20(1):1–19
Kataoka K, Katai H, Mizusawa J, Katayama H, Nakamura K, Morita S, Yoshikawa T, Ito S, Kinoshita T, Fukagawa T, Sasako M, Stomach Cancer Study Group/Japan Clinical Oncology Group (2016) Non-randomized confirmatory trial of laparoscopy-assisted total gastrectomy and proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group Study JCOG1401. J Gastric Cancer 16(2):93–97
Kinoshita T, Uyama I, Terashima M, Noshiro H, Nagai E, Obama K, Tamamori Y, Nabae T, Honda M, Abe T, LOC-A Study Group (2018) Long-term outcomes of laparoscopic versus open surgery for clinical stage II/III gastric cancer: a multicenter cohort study in Japan (LOC-A study). Ann Surg. https://doi.org/10.1097/SLA.0000000000002768
Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, Phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39(11):2734–2741
Tokunaga M, Sugisawa N, Kondo J, Tanizawa Y, Bando E, Kawamura T, Terashima M (2014) Early Phase II study of robot-assisted distal gastrectomy with nodal dissection for clinical stage IA gastric cancer. Gastric Cancer 17(3):542–547
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(2):305–311
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(1):146–151
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(6):1774–1778
Kimura H, Ishikawa M, Nabae T, Matsunaga T, Murakami S, Kawamoto M, Kamimura T, Uchiyama A (2017) Internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer. Asian J Surg 40(3):203–209
Capella RF, Iannace VA, Capella JF (2006) Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg 203(3):328–335
Geubbels N, Lijftogt N, Fiocco M, van Leersum NJ, Wouters MW, de Brauw LM (2015) Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg 102(5):451–460
Schneider C, Cobb W, Scott J, Carbonell A, Myers K, Bour E (2011) Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc 25(5):1594–1598
Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A (2005) Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 19(1):34–39
Miyashiro LA, Fuller WD, Ali MR (2010) Favorable internal hernia rate achieved using retrocolic, retrogastric alimentary limb in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 6(2):158–162
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
Baba A, Yamazoe S, Dogru M, Okuyama Y, Mogami T, Kobashi Y, Nozawa Y, Aoyagi Y, Fujisaki H, Ogura M, Matsui J (2015) Petersen hernia after open gastrectomy with Roux-en-Y reconstruction: a report of two cases and literature review. Springerplus 4:753
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(10):3400–3404
Takayama Y, Kaneoka Y, Maeda A, Fukami Y, Takahashi T, Onoe S, Uji M (2018) Internal hernia after proximal gastrectomy with jejunal interposition. Updates Surg 70(1):85–90
Ojima T, Nakamori M, Nakamura M, Katsuda M, Hayata K, Kato T, Tsuji T, Yamaue H (2017) Internal hernia after laparoscopic total gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech 27(6):470–473
Han WH, Eom BW, Yoon HM, Kim YW, Ryu KW (2018) Clinical characteristics and surgical outcomes of internal hernia after gastrectomy in gastric cancer patients: retrospective case control study. Surg Endosc. https://doi.org/10.1007/s00464-018-6584-3. Accessed 12 Nov 2018
Kanda Y (2013) Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant 48:452–458
Hope WW, Sing RF, Chen AY, Lincourt AE, Gersin KS, Kuwada TS, Heniford BT (2010) Failure of mesenteric defect closure after Roux-en-Y gastric bypass. JSLS 14:213–216
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
Mathieu D, Luciani A (2004) Internal abdominal herniations. Am J Roentgenol 183:397–404
Acknowledgments
Not applicable.
Funding
We did not receive any financial support from any institutions.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Tetsuro Toriumi, Rie Makuuchi, Satoshi Kamiya, Yutaka Tanizawa, Etsuro Bando, and Masanori Terashima have no conflict of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Toriumi, T., Makuuchi, R., Kamiya, S. et al. Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer. Surg Endosc 34, 436–442 (2020). https://doi.org/10.1007/s00464-019-06787-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-06787-x