J Minim Invasive Surg.  2021 Mar;24(1):18-25. 10.7602/jmis.2021.24.1.18.

Clinical features of internal hernia after gastrectomy for gastric cancer

Affiliations
  • 1Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 3Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
  • 4Department of Surgery, Pusan National University Hospital, Busan, Korea
  • 5Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 6Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 7Department of Surgery, Kosin University Gospel Hospital, Busan, Korea

Abstract

Purpose
Internal hernia after gastrectomy is a rare but potentially life-threatening condition without surgical intervention. Clinical risk factors of internal hernia should, hence, be reviewed after gastrectomy. From 2008 to 2018, patients who underwent gastrectomy for gastric cancer were investigated.
Methods
Abdominal computed tomography (CT) was used to screen for internal hernia, and surgical exploration was performed to confirm the diagnosis. Using retrospective statistical analysis, the incidence, characteristics, and risk factors were identified, and the characteristics of the internal hernia group were reviewed.
Results
The overall incidence of internal hernia was 0.9%. From statistical analysis, it was found that laparoscopic surgery was almost five times riskier than open gastrectomy (odds ratio [OR], 4.947; 95% confidence interval [CI], 1.308–18.710; p = 0.019). Body mass index < 25 kg/m2 (OR, 4.596; 95% CI, 1.056– 20.004; p = 0.042) and proximal gastrectomy (OR, 4.238; 95% CI, 1.072–16.751; p = 0.039) were also associated with internal hernia. Among 20 patients with internal hernia, 12 underwent laparotomy, and five had their bowels removed due to ischemia. All patients with bowel resected had suffered from short bowel syndrome.
Conclusion
Suspecting an internal hernia should be an important step when a patient with a history of laparoscopic gastrectomy visits for medical care. When suspected, emergent screening through CT scan and surgical intervention should be considered as soon as possible to prevent lifetime complications accordingly.

Keyword

Abdominal hernia; Gastrectomy; Laparoscopy; Stomach neoplasms; Short bowel syndrome
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