title: Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer.
abstract: BACKGROUND
  Although the internal hernias have been a huge topic in the field of bariatric surgery, there were a few reports in gastric cancer. The purpose of this study was to analyze the incidence, clinical features, and prevention of internal hernia after gastrectomy for gastric cancer.
  
  
  METHODS
  Twelve patients who underwent surgical treatment for internal hernia in our hospital after gastrectomy were analyzed. Features, including incidence, symptoms, and signs, were investigated in detail.
  
  
  RESULTS
  The operative procedures for preceding gastrectomies were open distal gastrectomy in three patients, open total gastrectomy in three patients, laparoscopic-assisted distal gastrectomy in two patients, and laparoscopic total gastrectomy in four patients. The most frequent sites of internal hernias were jejunojejunostomy mesenteric defects (five patients) and Petersen's defect (five patients), mesenterium of transverse colon (one patient), and esophagus hiatus (one patient). There was no significant difference between open and laparoscopic preceding gastrectomies. After closure of the mesenteric defect was introduced, no further internal hernias occurred. On CT examination, the whirl sign was present in ten patients on 3D images.
  
  
  CONCLUSIONS
  The present data suggest the importance of early recognition and treatment of internal hernia, as well as its prevention by closure of mesenteric defects.
authors.affiliation: Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan, yoshikawa.kozo@tokushima-u.ac.jp.
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Kurita
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sato
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Jun
authors.initials: J
authors.lastname: Higashijima
authors.forename: Motoya
authors.initials: M
authors.lastname: Chikakiyo
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nishi
authors.forename: Hideya
authors.initials: H
authors.lastname: Kashihara
authors.forename: Chie
authors.initials: C
authors.lastname: Takasu
authors.forename: Noriko
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Syohei
authors.initials: S
authors.lastname: Eto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D015390:Gastric Bypass / Q000379:methods; D006547:Hernia / Q000000981:diagnostic imaging* / Q000209:etiology*; D059685:Herniorrhaphy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007410:Intestinal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed