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Internal Hernia After Laparoscopic Total Gastrectomy for Gastric Cancer
Toshiyasu Ojima1, Mikihito Nakamori, Masaki Nakamura
1Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Purpose:
The aim of this study was to clarify internal hernia (IH) characteristics after laparoscopic gastrectomy.
Materials And Methods:
This was a retrospective study of 1943 consecutive gastric cancer patients who underwent surgery at our institute between 2004 and 2015. Since 2013, our technique includes antecolic Roux-en-Y (RY) with closure of all mesenteric defects during laparoscopic total gastrectomy (LTG) as standard.
Results:
Postoperative IH was only detected in patients who underwent total gastrectomy with RY reconstruction. Furthermore, the incidence of IH was significantly higher after LTG than after open total gastrectomy (4.9% vs. 1.0%; P=0.005). IH after LTG occurred in 8.0% of patients before standardization with closure of the mesenteric defects, but no IH was observed after standardization (P=0.047).
Conclusions:
Closure of all mesenteric defects is recommended for gastric cancer patients who undergo LTG with antecolic RY. Registration number: UMIN000009163/000025029 (www.umin.ac.jp/ctr/).
