title: Internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer.
abstract: OBJECTIVE
  Laparoscopic gastrectomy (LG) is increasingly used to treat gastric cancer. Simultaneously, internal hernia (IH) has been reported after LG with Roux-en-Y reconstruction (RY). The aim of this study was to investigate IH after LG with RY for gastric cancer.
  
  
  METHODS
  This study included 15 patients with IH from a database of 355 consecutive patients who underwent LG with RY for gastric cancers. We retrospectively analyzed IH incidence and clinical characteristics by operative procedures.
  
  
  RESULTS
  The total incidence of IH was 4.2%. The incidence of IH at Petersen's defect tended to decrease with modifications to the reconstruction methods, but not significantly so. The incidence of IH at jejunojejunostomy mesenteric defect significantly decreased with closure of this defect (p = 0.01). The incidence of IH at transverse mesocolic defect was 1.3% in patients who underwent retrocolic RY; emergent small-bowel resection was only required in two cases of herniation through this defect after laparoscopic total gastrectomy.
  
  
  CONCLUSIONS
  Retrocolic RY with appropriate closure of defects can reduce IH incidence at Petersen's defect and at jejunojejunostomy mesenteric defect. Although the IH incidence at the transverse mesocolic defect is not particularly high, the possibility of herniation through this defect should be kept in mind.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan. Electronic address: hideyo-k@surg1.med.kyushu-u.ac.jp.
authors.forename: Hideyo
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Mikimasa
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Toshinaga
authors.initials: T
authors.lastname: Nabae
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Taketo
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawamoto
authors.affiliation: Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kamimura
authors.affiliation: Department of Surgery, Japan Community Health care Organization, Kyushu Hospital, Fukuoka, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Roux-en-Y reconstruction; gastric cancer; internal hernia; laparoscopic gastrectomy