title: Easy and secure closure of petersen's defect after laparoscopic distal gastrectomy with Roux-en-Y reconstruction.
abstract: BACKGROUND
  Previously it has reported that the incidence of internal hernia can be decreased by closing Petersen's defect, but the perfect closure method, in fact, has not been discovered yet. In this study we have developed an easy and reliable method for closing Petersen's defect in the Roux-en-Y reconstruction after a laparoscopic distal gastrectomy.
  
  
  METHODS
  We performed intracorporeal Roux-en-Y reconstruction after laparoscopic distal gastrectomy with antiperistaltic gastrojejunostomy. The greater omentum is placed on the cranial side of the transverse colon through the defect between the elevated jejunum and the transverse mesocolon. Anastomosis is performed of the transverse mesocolon attached to the transverse colon, the greater omentum is passed through the Petersen's defect, and the stump of the mesojejunum is attached to the elevated jejunum by an interrupted suture. Petersen's defect is spread and straightened to stabilize the visual field. The thread is inserted first at the base of the stump of the elevated mesojejunum, next to the greater omentum, which has passed through Petersen's defect, and then to the transverse mesocolon to set the starting point of continuous suture. The stitches of continuous suture are sewn toward the transverse colon. Petersen's defect is closed completely.
  
  
  RESULTS
  We performed this technique in 37 patients. All procedures were completed without intraoperative complication or conversion to laparotomy. During the follow-up period, none of the patients developed complications related to the internal hernia, such as Petersen's hernia.
  
  
  CONCLUSIONS
  We have indicated a novel, easy, and secure closure procedure of Petersen's defect following laparoscopic distal gastrectomy with Roux-en-Y reconstruction.
authors.affiliation: Department of Digestive and General Surgery, Shimane University Faculty of Medicine , Izumo, Shimane, Japan .
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Hirahara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsubara
authors.forename: Hikota
authors.initials: H
authors.lastname: Hayashi
authors.forename: Kiyoe
authors.initials: K
authors.lastname: Takai
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujii
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013537:Sutures / Q000009:adverse effects