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KMID : 1035920210240010018
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Journal of Minimally Invasive Surgery
2021 Volume.24 No. 1 p.18 ~ p.25
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Clinical features of internal hernia after gastrectomy for gastric cancer
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Ahn Hong-Min
Lee Si-Hak
Jeon Tae-Yong
Kim Dae-Hwan
Choi Chang-In
Kim Su-Jin
Choi Cheol-Woong
Kim Tae-Un
Kim Ki-Hyun
Hwang Sun-Hwi
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Abstract
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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.
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KEYWORD
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Abdominal hernia, Gastrectomy, Laparoscopy, Stomach neoplasms, Short bowel syndrome
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