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 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 4 September 2013" - "CODEN: SURGA" - "Source: Scopus" |
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