Prevalence of internal hernias after laparoscopic colonic surgery.
BACKGROUND
Laparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection.


METHODS
During a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention.


RESULTS
A total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h.


CONCLUSIONS
Internal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific.


CONCLUSIONS
All mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed.
Sereno Trabaldo
Stefano
S
Servicio de Cirugía Bariátrica y Metabólica, Real San José Hospital, Tarascos 3514-6, Fracc. Monraz, CP 44670, Guadalajara, Jalisco, México. ssereno@gmail.com
Anvari
Mehran
M
Leroy
Joel
J
Marescaux
Jacques
J
D000368:Aged; D003107:Colorectal Surgery; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome