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Internal herniation following laparoscopic left hemicolectomy: an underreported event
Avanish Saklani1, Nader Naguib, Nicola Tanner
1Colorectal Surgery Department, Prince Charles Hospital, Merthyr Tydfil, United Kingdom.
Summary
Laparoscopic left hemicolectomy significantly increases the risk of internal herniation and subsequent small bowel obstruction. Alternative surgical approaches may reduce this complication.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic colorectal surgery generally results in fewer adhesions than open surgery.
- Small bowel obstruction (SBO) post-laparoscopic colorectal resection can stem from internal herniation through defects, particularly after left colectomies.
Observation:
- A literature review identified 9 cases of SBO after laparoscopic left colorectal resection.
- Two additional cases are presented, detailing etiology, diagnosis, and management.
- In this study, 50% of laparoscopic left hemicolectomies resulted in SBO, with 2 requiring surgical intervention for internal hernia.
Findings:
- Laparoscopic left hemicolectomy is associated with a higher incidence of internal herniation and SBO compared to other laparoscopic colorectal procedures (P = .006).
- Internal herniation through colomesenteric defects is a likely cause of SBO in these patients.
Implications:
- Laparoscopic left hemicolectomy poses a significant risk for internal herniation.
- Consider laparoscopic subtotal colectomy or performing anastomosis through the small bowel mesentery to mitigate this risk.
