title: Recent trend of internal hernia occurrence after gastrectomy for gastric cancer.
abstract: BACKGROUND
  The incidence of internal hernia after gastrectomy can increase with the increasing use of laparoscopic surgery, although this trend has not been elucidated.
  
  
  METHODS
  Clinical information was collected from medical records and by questionnaire for 18 patients who underwent surgical treatment for internal hernia after gastrectomy for gastric cancer in 24 hospitals from January 2005 to December 2009.
  
  
  RESULTS
  Gastrectomy for gastric cancer was open/distal gastrectomy (DG) in five (28%) patients, open/total gastrectomy (TG) in seven (39%), laparoscopy-assisted/DG in three (17%), and laparoscopy-assisted/TG in 3 (17%). Reconstruction was by Roux-Y methods in all patients. The hernia orifice was classified as a jejunojejunostomy mesenteric defect in eight patients (44%), dorsum of the Roux limb (Petersen's space) in eight (44%), and one (5%) each of esophageal hiatus and mesenterium of the transverse colon. Among 8,983 patients who underwent gastrectomy for gastric cancer, a postoperative survey revealed that 13 patients underwent surgical treatment for internal hernia in the same hospitals. The 3-year incidence rate of the internal hernia was 0.19%, which was significantly higher after laparoscopy-assisted than open gastrectomy (0.53 vs. 0.15%, p = 0.03). Patients with an internal hernia had a mean (±SD) low weight at hernia operation (body mass index 17.9 ± 1.6 kg/m(2)) and marked weight loss after gastrectomy (weight reduction 15.6 ± 5.8%).
  
  
  CONCLUSIONS
  Gastrectomy with Roux-Y reconstruction for gastric cancer leaves several spaces that can cause internal hernia formation. Laparoscopic surgery and postoperative body weight loss are potential risk factors.
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Miyagaki
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tamura
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kimura
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006547:Hernia / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D059685:Herniorrhaphy; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*