Kyung Min Kang, Sa-Hong Min, Yoon Taek Lee, Ki Bum Park, Young Suk Park, Sang-Hoon Ahn, Do Joong Park, Hyung-Ho Kim. Seoul National University Bundang Hospital
Purpose: Laparoscopic gastrecomy has been widely adopted as the treatment of choice by many countries and institutions. Internal hernia is a well-known complication after Rouxen-Y gastric bypass in the field of bariatric surgery. However, there were only a few reports of internal hernia after gastrectomy in gastric cancer patients. The purpose of this study was to analyze the incidence and clinical features of internal hernia after gastric cancer surgery in a high-volume center.
Method: 2,931 gastric cancer patients who underwent curative gastrectomy at Seoul National University Bundang Hospital between January 2013 and December 2016 were retrospectively reviewed in this study. Internal hernia was classified into two types, Mesenteric hernia and Petersen's hernia.
Result: 2201 patients who underwent distal gastrectomy (DG) with reconstruction by Billroth II, Rouxen-Y gastrojejunostomy and uncut Rouxen-Y gastrojejunostomy, total gastrectomy (TG) with Esophagojejunostomy, and proximal gastrectomy with double tract reconstruction (PG DTR) with esophagojejunostomy and gastrojejunostomy had potential space for internal hernia. Among these patients, 31 (1.4%) were determined as internal hernia by Computed Tomography and 29 patients (1.3%) underwent surgical treatment of internal herniation. Two patients were conservatively managed. All patients suffered from abdominal pain and 13/31(42%) patients showed nausea and vomiting. The median interval between the initial gastrectomy and surgery for internal hernia was 450 days. Mesenteric hernia was observed in 18 cases and Petersen’s hernia in 12 cases. Since we started closing the mesenteric and Petersen's defects from May of 2015, there were only 5 cases (16%) observed afterwards but there were 24 cases (84%) before closure of the defects.
Conclusion: Internal hernia after gastrectomy is likely underreported. Although we analyzed 31 patients with internal hernia, there might be more patients with mild symptoms who were managed conservatively by their own. A high degree of suspiciousness for internal hernia should be maintained in patients presenting symptoms like nausea, vomiting and abdominal pain after gastrectomy with potential space for internal hernia. With our experience, closure of the mesenteric and Petersen's defect is helpful in reducing internal hernia. However, due to low incidence, a multi-center retrospective study is necessary.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86939
Program Number: P427
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster