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Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer

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Abstract

Background

Although the internal hernias have been a huge topic in the field of bariatric surgery, there were a few reports in gastric cancer. The purpose of this study was to analyze the incidence, clinical features, and prevention of internal hernia after gastrectomy for gastric cancer.

Methods

Twelve patients who underwent surgical treatment for internal hernia in our hospital after gastrectomy were analyzed. Features, including incidence, symptoms, and signs, were investigated in detail.

Results

The operative procedures for preceding gastrectomies were open distal gastrectomy in three patients, open total gastrectomy in three patients, laparoscopic-assisted distal gastrectomy in two patients, and laparoscopic total gastrectomy in four patients. The most frequent sites of internal hernias were jejunojejunostomy mesenteric defects (five patients) and Petersen’s defect (five patients), mesenterium of transverse colon (one patient), and esophagus hiatus (one patient). There was no significant difference between open and laparoscopic preceding gastrectomies. After closure of the mesenteric defect was introduced, no further internal hernias occurred. On CT examination, the whirl sign was present in ten patients on 3D images.

Conclusions

The present data suggest the importance of early recognition and treatment of internal hernia, as well as its prevention by closure of mesenteric defects.

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References

  1. Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T (2012) Recent trend internal occurrence after gastrectomy for gastric cancer. World J Surg 36:851–857

    Article  PubMed  Google Scholar 

  2. Hosoya Y, Lefor A, Ui T, Haruta H, Kurashina K, Saito S (2011) Internal hernia after laparoscopic gastric resection with antecolic Roux-en-Y reconstruction for gastric cancer. Surg Endosc 25:3400–3404

    Article  PubMed  Google Scholar 

  3. Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A (2005) Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 19:34–39

    Article  CAS  PubMed  Google Scholar 

  4. Onopchenko A (2005) Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass. Obes Surg 15:606–611

    Article  PubMed  Google Scholar 

  5. Steele KE, Prokopowicz GP, Magnuson T, Lidor A, Schweitzer M (2008) Laparoscopic antecolic Roux-En-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc 22:2056–2061

    Article  CAS  PubMed  Google Scholar 

  6. Escalona A, Devaud N, Perez G, Crovari F, Boza C, Viviani P (2007) Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis 3:423–427

    Article  PubMed  Google Scholar 

  7. Gunabushanam G, Shankar S, Czerniach D, Kelly JJ, Perugini RA (2009) Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass surgery. J Comput Assist Tomogr 33:369–375

    Article  PubMed  Google Scholar 

  8. Hwang RF, Swartz DE, Felix EL (2004) Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 18:1631–1635

    Article  CAS  PubMed  Google Scholar 

  9. Coleman MH, Awad ZT, Pomp A, Gagner M (2006) Laparoscopic closure of the Petersen mesenteric defect. Obes Surg 16:770–772

    Article  PubMed  Google Scholar 

  10. Bauman RW, Pirrello JR (2009) Internal hernia at Petersen’s space after laparoscopic Roux-en-Y gastric bypass: 6.2 % incidence without closure. A single-surgeon series of 1047 cases. Surg Obes Relat Dis 5:565–570

    Article  PubMed  Google Scholar 

  11. Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S (2011) Different features of complications with Billroth-I and Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy. J Gastrointest Surg 15:2145–2152

    Article  PubMed  Google Scholar 

  12. Garza E Jr, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T (2004) Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg 188:769–800

    Article  Google Scholar 

  13. Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 13:350–354

    Article  PubMed  Google Scholar 

  14. Blachar A, Federle MP (2002) Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery in patients who are morbidly obese: findings on radiography and CT. AJR Am J Roentgenol 179:1437–1442

    Article  PubMed  Google Scholar 

  15. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234:279–291

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Carmody B, DeMaria EJ, Jamal M, Johnson J, Carbonell A, Kellum J (2005) Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Dis 1:543–548

    Article  Google Scholar 

  17. Cruz-Munoz N, Cabrera JC, Cuesta M, Hartnett S, Rojas R (2011) Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 7:176–180

    Article  PubMed  Google Scholar 

  18. Cho M, Pinto D, Carrodeguas L, Lascano C, Soto F, Whipple O (2006) Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases. Surg Obes Relat Dis 2:87–91

    Article  PubMed  Google Scholar 

  19. Koppman JS, Li C, Gandsas A (2008) Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9527 patients. J Am Coll Surg 206:571–584

    Article  PubMed  Google Scholar 

  20. Ito Y, loka A, Tsukuma H, Ajiki W, Sugimoto T, Rachet B, Coleman MP (2009) Regional differences in population-based cancer survival between six prefectures in Japan. Cancer Sci 100:1306–1311

    Article  CAS  PubMed  Google Scholar 

  21. Felsher J, Brodsky J, Brody F (2003) Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 134:501–505

    Article  PubMed  Google Scholar 

  22. Ahmed R, Miskovic D, Vijayaseelan T, O’Malley W, Hanna GB (2012) Root cause analysis of internal hernia and roux limb compression after laparoscopic Roux-en-Y gastric bypass using observation clinical human reliability assessment. Surg Obes Relat Dis 8:158–163

    Article  PubMed  Google Scholar 

  23. Higa KD, Boone KB, Ho T, Davies OG (2000) Laparoscopic Roux-en-Y gastric bypass for morbid obesity. Arch Surg 135:1029–1034

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Drs. Kozo Yoshikawa, Mitsuo Shimada, Nobuhiro Kurita, Hirohiko Sato, Jun Higashijima, Hideya Kashihara have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Kozo Yoshikawa, Mitsuo Shimada, Nobuhiro Kurita, Hirohiko Sato, Takashi Iwata, Jun Higashijima, Motoya Chikakiyo, Masaaki Nishi, Hideya Kashihara, Chie Takasu, Noriko Matsumoto & Syohei Eto

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  1. Kozo Yoshikawa
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  2. Mitsuo Shimada
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  3. Nobuhiro Kurita
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  4. Hirohiko Sato
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  5. Takashi Iwata
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  6. Jun Higashijima
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  7. Motoya Chikakiyo
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  8. Masaaki Nishi
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  9. Hideya Kashihara
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  10. Chie Takasu
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  11. Noriko Matsumoto
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  12. Syohei Eto
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Corresponding author

Correspondence to Kozo Yoshikawa.

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Yoshikawa, K., Shimada, M., Kurita, N. et al. Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Surg Endosc 28, 1774–1778 (2014). https://doi.org/10.1007/s00464-013-3384-7

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  • DOI: https://doi.org/10.1007/s00464-013-3384-7

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