Internal hernia after gastrectomy for cancer with Roux-Y reconstruction Journal Article

Authors: Kelly, K. J.; Allen, P. J.; Brennan, M. F.; Gollub, M. J.; Coit, D. G.; Strong, V. E.
Article Title: Internal hernia after gastrectomy for cancer with Roux-Y reconstruction
Abstract: Background: The incidence of internal hernia (IH) after gastrectomy for cancer with Roux-Y reconstruction has not been well-defined. This study aimed to define the true incidence of IH after gastrectomy for cancer with Roux-Y reconstruction; to describe the presentation, timing, and management of this complication; and to identify factors associated with IH. Methods: Clinical and follow-up information were reviewed for all patients who underwent open or laparoscopic gastrectomy with Roux-Y reconstruction for cancer at a single institution from January 2005 through April 2012. Results: A total of 298 patients underwent gastrectomy for cancer with Roux-Y reconstruction. At a median follow-up of 22.4 months, we identified 16 patients (5%) who underwent subsequent reoperation for IH. No patient who had closure of mesenteric defects developed IH. IH occurred in 1 of 99 patients after open subtotal gastrectomy (1%), 10 of 165 after open total gastrectomy (6%), 1 of 16 after laparoscopic subtotal gastrectomy (6%), and 4 of 18 after laparoscopic total gastrectomy (22%; P <.03). On univariate analysis, younger age, lower body mass index, no previous abdominal surgery, laparoscopic approach, and total gastrectomy were associated with IH. IH tended to occur early after laparoscopic gastrectomy (median, 7 months) and late after open gastrectomy (median, 24 months). Conclusion: IH after gastrectomy with Roux-Y reconstruction is likely underreported. A high degree of suspicion for IH should be maintained in patients presenting with emesis or abdominal pain after gastrectomy with Roux-Y reconstruction, especially after laparoscopic or total gastrectomy. Closure of mesenteric defects after laparoscopic and total gastrectomy should be considered when technically feasible. © 2013 Mosby, Inc. All rights reserved.
Keywords: adult; controlled study; aged; aged, 80 and over; middle aged; major clinical study; follow up; incidence; postoperative complications; body mass; hernia; reoperation; gastrectomy; stomach cancer; abdominal surgery; stomach neoplasms; total stomach resection; anastomosis, roux-en-y; internal hernia; choledochojejunostomy
Journal Title: Surgery
Volume: 154
Issue: 2
ISSN: 0039-6060
Publisher: Elsevier Inc.  
Date Published: 2013-08-01
Start Page: 305
End Page: 311
Language: English
DOI: 10.1016/j.surg.2013.04.027
PROVIDER: scopus
PUBMED: 23889956
Notes: --- - "Export Date: 4 September 2013" - "CODEN: SURGA" - "Source: Scopus"
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MSK Authors
  1. Murray F Brennan
    781 Brennan
  2. Marc J Gollub
    111 Gollub
  3. Kaitlyn J Kelly
    28 Kelly
  4. Peter Allen
    442 Allen
  5. Vivian Strong
    148 Strong
  6. Daniel Coit
    422 Coit