Risk factors of symptomatic internal hernias after left hemicolectomy: a multicenter retrospective study

Mesenteric-related internal hernia after left hemicolectomy is rare. However, it can cause serious consequences, including upper gastrointestinal obstruction and acute intestinal necrosis. This study aimed to explore the potential risk factors of symptomatic internal hernia (SIH) after a left hemicolectomy.

We retrospectively reviewed the data of patients who underwent a left hemicolectomy at 10 tertiary hospitals between January 2018 and June 2024. Their baseline information, surgical procedures, and early postoperative complications (within 3 months after surgery) were recorded and analyzed.

Overall, 468 patients were included in this study, the majority of patients underwent laparoscopic surgery (76.9%). SIH was detected using postoperative imaging (computed tomography/upper gastrointestinal contrast). Six patients (1.28%) developed SIH (SIH group) and underwent re-operation. Compared with the 462 patients who did not develop SIH (non-SIH group) (with comparable baseline data between groups), the SIH group did not undergo surgery to close the mesenteric defect (0 vs. 56.1%; p = 0.008) and had longer durations of postoperative hospital stay (50.5 ± 37.1 days vs. 14.6 ± 6.4 days; p < 0.001). Relative to the patients without mesenteric defect closure, those who had closure of the mesenteric defects did not have significantly increased duration of surgery (β = - 0.40, 95% CI = - 12.60 to 11.81, p = 0.949) or incidence of postoperative complications other than SIH (β = 0.79, 95% CI = 0.43 to 1.45, p = 0.443).

The risk of SIH after left hemicolectomy may increase if closure of the mesenteric defect is not performed. We recommend appropriate management of the mesenteric defect after left hemicolectomy to prevent SIH.