Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era

Kyong Min Kang, Yo Seok Cho, Sa Hong Min, Yoontaek Lee, Ki Bum Park, Young Suk Park, Sang Hoon Ahn, Do Joong Park, Hyung-Ho Kim

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and risk factors for internal hernia after gastrectomy for gastric cancer. Methods: We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors. Results: Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7%) and the median interval time was 450 days after gastrectomy. Fourteen (0.9%) of the 1510 patients who underwent open gastrectomy and 97 (2.0%) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0%), 9 (1.1%), 40 (3.1%), 56 (3.3%), 6 (2.3%), and 0 (0%) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2%) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2%), 27 (45.8%), and 0 (0%) were identified in jejunojejunostomy mesenteric, Petersen’s, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (P < 0.01), laparoscopic approach (P < 0.01), and totally laparoscopic approach (P = 0.03) were independent risk factors for internal hernia. Conclusions: The potential spaces such as Petersen’s, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.

Original languageEnglish
Pages (from-to)1009-1015
Number of pages7
JournalGastric Cancer
Volume22
Issue number5
DOIs
StatePublished - 5 Sep 2019

Fingerprint

Minimally Invasive Surgical Procedures
Gastrectomy
Hernia
Stomach Neoplasms
Gastroenterostomy
Transverse Colon
Multivariate Analysis
Logistic Models
Tomography

Keywords

  • Gastrectomy
  • Gastric cancer
  • Hernia
  • Laparoscopy
  • Risk factors

Cite this

Kang, Kyong Min ; Cho, Yo Seok ; Min, Sa Hong ; Lee, Yoontaek ; Park, Ki Bum ; Park, Young Suk ; Ahn, Sang Hoon ; Park, Do Joong ; Kim, Hyung-Ho. / Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era. In: Gastric Cancer. 2019 ; Vol. 22, No. 5. pp. 1009-1015.
@article{23d7514c8e99478ab198007f18a6b15a,
title = "Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era",
abstract = "Background: The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and risk factors for internal hernia after gastrectomy for gastric cancer. Methods: We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors. Results: Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7{\%}) and the median interval time was 450 days after gastrectomy. Fourteen (0.9{\%}) of the 1510 patients who underwent open gastrectomy and 97 (2.0{\%}) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0{\%}), 9 (1.1{\%}), 40 (3.1{\%}), 56 (3.3{\%}), 6 (2.3{\%}), and 0 (0{\%}) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2{\%}) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2{\%}), 27 (45.8{\%}), and 0 (0{\%}) were identified in jejunojejunostomy mesenteric, Petersen’s, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (P < 0.01), laparoscopic approach (P < 0.01), and totally laparoscopic approach (P = 0.03) were independent risk factors for internal hernia. Conclusions: The potential spaces such as Petersen’s, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.",
keywords = "Gastrectomy, Gastric cancer, Hernia, Laparoscopy, Risk factors",
author = "Kang, {Kyong Min} and Cho, {Yo Seok} and Min, {Sa Hong} and Yoontaek Lee and Park, {Ki Bum} and Park, {Young Suk} and Ahn, {Sang Hoon} and Park, {Do Joong} and Hyung-Ho Kim",
year = "2019",
month = "9",
day = "5",
doi = "10.1007/s10120-019-00931-1",
language = "English",
volume = "22",
pages = "1009--1015",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",
number = "5",

}

Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era. / Kang, Kyong Min; Cho, Yo Seok; Min, Sa Hong; Lee, Yoontaek; Park, Ki Bum; Park, Young Suk; Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung-Ho.

In: Gastric Cancer, Vol. 22, No. 5, 05.09.2019, p. 1009-1015.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era

AU - Kang, Kyong Min

AU - Cho, Yo Seok

AU - Min, Sa Hong

AU - Lee, Yoontaek

AU - Park, Ki Bum

AU - Park, Young Suk

AU - Ahn, Sang Hoon

AU - Park, Do Joong

AU - Kim, Hyung-Ho

PY - 2019/9/5

Y1 - 2019/9/5

N2 - Background: The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and risk factors for internal hernia after gastrectomy for gastric cancer. Methods: We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors. Results: Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7%) and the median interval time was 450 days after gastrectomy. Fourteen (0.9%) of the 1510 patients who underwent open gastrectomy and 97 (2.0%) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0%), 9 (1.1%), 40 (3.1%), 56 (3.3%), 6 (2.3%), and 0 (0%) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2%) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2%), 27 (45.8%), and 0 (0%) were identified in jejunojejunostomy mesenteric, Petersen’s, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (P < 0.01), laparoscopic approach (P < 0.01), and totally laparoscopic approach (P = 0.03) were independent risk factors for internal hernia. Conclusions: The potential spaces such as Petersen’s, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.

AB - Background: The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and risk factors for internal hernia after gastrectomy for gastric cancer. Methods: We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors. Results: Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7%) and the median interval time was 450 days after gastrectomy. Fourteen (0.9%) of the 1510 patients who underwent open gastrectomy and 97 (2.0%) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0%), 9 (1.1%), 40 (3.1%), 56 (3.3%), 6 (2.3%), and 0 (0%) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2%) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2%), 27 (45.8%), and 0 (0%) were identified in jejunojejunostomy mesenteric, Petersen’s, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (P < 0.01), laparoscopic approach (P < 0.01), and totally laparoscopic approach (P = 0.03) were independent risk factors for internal hernia. Conclusions: The potential spaces such as Petersen’s, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.

KW - Gastrectomy

KW - Gastric cancer

KW - Hernia

KW - Laparoscopy

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=85061579432&partnerID=8YFLogxK

U2 - 10.1007/s10120-019-00931-1

DO - 10.1007/s10120-019-00931-1

M3 - Article

VL - 22

SP - 1009

EP - 1015

JO - Gastric Cancer

JF - Gastric Cancer

SN - 1436-3291

IS - 5

ER -