title: Internal herniation following laparoscopic left hemicolectomy: an underreported event.
abstract: OBJECTIVE
  Laparoscopic colorectal surgery creates fewer adhesions compared with open colorectal resection. Small bowel obstruction after laparoscopic colorectal resection may be caused by internal herniation of the small bowel through a colomesenteric defect, probably related to a lack of adhesion formation. This is seen especially after left colonic resections.
  
  
  METHODS
  A literature review was conducted using the key words "intestinal obstruction" and "laparoscopic left colonic resection," and 9 documented case reports of obstruction following laparoscopic left colorectal resection were identified. We present 2 additional cases and discuss the etiology, diagnosis, management, and possible options for avoiding this complication.
  
  
  RESULTS
  In total, 167 consecutive laparoscopic procedures were performed in our study, and 8 were left hemicolectomies. Four of these patients (50%) developed intestinal obstruction, with 2 requiring surgical intervention for internal hernia. For the remaining 159 colorectal procedures, there were only 2 admissions with intestinal obstruction, with 1 patient requiring surgery (P = .006).
  
  
  CONCLUSIONS
  Laparoscopic left hemicolectomy carries a significant risk of internal herniation. Performing a laparoscopic subtotal colectomy or fashioning the colocolonic anastomosis through the small bowel mesentery may minimize this risk.
authors.affiliation: Colorectal Surgery Department, Prince Charles Hospital, Merthyr Tydfil, United Kingdom.
authors.forename: Avanish
authors.initials: A
authors.lastname: Saklani
authors.forename: Nader
authors.initials: N
authors.lastname: Naguib
authors.forename: Nicola
authors.initials: N
authors.lastname: Tanner
authors.forename: Stephanie
authors.initials: S
authors.lastname: Moorhouse
authors.forename: Clare Elizabeth
authors.initials: CE
authors.lastname: Davies
authors.forename: Ashraf G
authors.initials: AG
authors.lastname: Masoud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D012086:Reoperation