title: Internal hernia after gastrectomy for cancer with Roux-Y reconstruction.
abstract: BACKGROUND
  The incidence of internal hernia (IH) after gastrectomy for cancer with Roux-Y reconstruction has not been well-defined. This study aimed to define the true incidence of IH after gastrectomy for cancer with Roux-Y reconstruction; to describe the presentation, timing, and management of this complication; and to identify factors associated with IH.
  
  
  METHODS
  Clinical and follow-up information were reviewed for all patients who underwent open or laparoscopic gastrectomy with Roux-Y reconstruction for cancer at a single institution from January 2005 through April 2012.
  
  
  RESULTS
  A total of 298 patients underwent gastrectomy for cancer with Roux-Y reconstruction. At a median follow-up of 22.4 months, we identified 16 patients (5%) who underwent subsequent reoperation for IH. No patient who had closure of mesenteric defects developed IH. IH occurred in 1 of 99 patients after open subtotal gastrectomy (1%), 10 of 165 after open total gastrectomy (6%), 1 of 16 after laparoscopic subtotal gastrectomy (6%), and 4 of 18 after laparoscopic total gastrectomy (22%; P < .03). On univariate analysis, younger age, lower body mass index, no previous abdominal surgery, laparoscopic approach, and total gastrectomy were associated with IH. IH tended to occur early after laparoscopic gastrectomy (median, 7 months) and late after open gastrectomy (median, 24 months).
  
  
  CONCLUSIONS
  IH after gastrectomy with Roux-Y reconstruction is likely underreported. A high degree of suspicion for IH should be maintained in patients presenting with emesis or abdominal pain after gastrectomy with Roux-Y reconstruction, especially after laparoscopic or total gastrectomy. Closure of mesenteric defects after laparoscopic and total gastrectomy should be considered when technically feasible.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Kaitlyn J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Gollub
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
mesh_terms: D000328:Adult; 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*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery*