title: Petersen's hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer.
abstract: BACKGROUND
  To decrease the incidence of internal hernia after laparoscopic Roux-en-Y gastric bypass, recent recommendations indicated closure of mesenteric defects and Petersen's defect. Laparoscopic distal gastrectomy for gastric cancer is used increasingly, so the incidence of Petersen's hernia can also increase, but the trend has not been studied.
  
  
  METHODS
  This study retrospectively reviewed 358 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer at one institution, with antecolic Roux-en-Y (RY) reconstruction.
  
  
  RESULTS
  Petersen's hernia occurred in 6 (2.2 %) of 268 patients whose Petersen's defect was not closed by a mean of 351 days after surgery. All the patients underwent reoperation with reduction and repair of the hernia except the first case. In 90 subsequent cases, with closure of the Petersen's defect, internal hernias did not occur (0/90 cases; p = 0.06). Focusing on the totally laparoscopic procedure, Petersen's hernia occurred in 2 (5.1 %) of 39 patients, whereas in 81 subsequent cases, with closure of Petersen's defect, internal hernias did not occur (0/81 cases; p = 0.03).
  
  
  CONCLUSIONS
  Based on the recent recommendations for bariatric surgery, closure of this potential hernia defect is necessary after laparoscopic distal gastrectomy with R-Y reconstruction for gastric cancer.
authors.affiliation: Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan, k-kojima.srg2@tmd.ac.jp.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kojima
authors.forename: Mikito
authors.initials: M
authors.lastname: Inokuchi
authors.forename: Keiji
authors.initials: K
authors.lastname: Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Motoyama
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*
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