Internal hernia after gastrectomy for gastric cancer: total gastrectomy as a potential risk factor

Internal hernia (IH) is an uncommon but potentially serious complication following gastrectomy for gastric cancer. While extensively studied in bariatric cohorts, data on IH following oncologic gastrectomy, particularly from Western centers, remain limited. With the increasing adoption of minimally invasive techniques, IH is becoming a more clinically relevant concern.

We conducted a retrospective study of 513 patients who underwent gastrectomy for gastric cancer at a single tertiary center between January 2012 and April 2025. Clinical, surgical, and postoperative variables were compared between patients with and without IH. Univariable analysis was followed by a parsimonious multivariable logistic regression model to evaluate factors associated with IH.

IH occurred in 20 patients (3.9%). Total gastrectomy (75% vs 36.7%, p = 0.001), minimally invasive approach (80% vs 56%, p = 0.033), and retrocolic reconstruction (95% vs 62.6%, p = 0.003) were more common among patients who developed IH. Most cases (95%) presented emergently, at a median of 32 weeks [IQR 7.3-66.8]. The retrocolic mesenteric defect was the most frequent site (60%). Bowel ischemia and perforation occurred in one patient each, with no mortality. In the parsimonious multivariable model, total gastrectomy (OR 4.92, 95% CI 1.70-14.26; p = 0.003) and minimally invasive approach (OR 3.93, 95% CI 1.26-12.30; p = 0.019) remained associated with IH.

IH is an uncommon but clinically significant complication after gastrectomy for gastric cancer. Total gastrectomy and minimally invasive remained associated with increased IH risk in a parsimonious multivariable model. These findings suggest that patients undergoing total gastrectomy may represent a higher-risk subgroup and warrant heightened clinical awareness.