Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer. View Full Text


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Article Info

DATE

2019-04-08

AUTHORS

Tetsuro Toriumi, Rie Makuuchi, Satoshi Kamiya, Yutaka Tanizawa, Etsuro Bando, Masanori Terashima

ABSTRACT

BACKGROUND: Internal hernia (IH) is a life-threatening complication after gastrectomy. The increase in the frequency of minimally invasive surgery is considered to be related to the increase in the frequency of IH, and mesenteric defect closure has been recommended to reduce this complication. However, IH can occur even when mesenteric defects are closed, so the risk of IH in the patients with mesenteric closure remains uncertain. We attempted to clarify the risk factors for IH in these patients. METHODS: From 2013 to 2017, we retrospectively reviewed 310 patients with gastric cancer who underwent laparoscopic or robot-assisted gastrectomy with Roux-en-Y (RY) or double-tract (DT) reconstruction with mesenteric defect closure. Univariate and multivariate analyses were performed to identify the risk factors. RESULTS: The incidence of IH was 1.3% (n = 4). A preoperative body mass index (BMI) ≥ 25 kg/m2 (p = 0.044), postoperative chemotherapy (p = 0.034), and body weight loss rate at 6 months ≥ 15% (p = 0.045) were risk factors for IH on a univariate analysis. A multivariate analysis showed that a BMI at the time of surgery of ≥ 25 kg/m2 was an independent risk factor for IH (odds ratio = 11.9, p = 0.049). CONCLUSIONS: Preoperative obesity is an independent risk factor for IH after minimally invasive gastrectomy followed by RY or DT reconstruction with mesenteric defect closure. We need to conduct vigilant follow-up for IH, especially in these patients. More... »

References to SciGraph publications

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  • 2017-01. Japanese gastric cancer treatment guidelines 2014 (ver. 4) in GASTRIC CANCER
  • 2014-01. Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer in GASTRIC CANCER
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  • 2011-10. Internal hernia after laparoscopic gastric resection with antecolic Roux-en-Y reconstruction for gastric cancer in SURGICAL ENDOSCOPY
  • 2005-01. Symptomatic internal hernias after laparoscopic bariatric surgery in SURGICAL ENDOSCOPY
  • 2018-11-12. Clinical characteristics and surgical outcomes of internal hernia after gastrectomy in gastric cancer patients: retrospective case control study in SURGICAL ENDOSCOPY
  • 2015-11. A Multi-institutional, Prospective, Phase II Feasibility Study of Laparoscopy-Assisted Distal Gastrectomy with D2 Lymph Node Dissection for Locally Advanced Gastric Cancer (JLSSG0901) in WORLD JOURNAL OF SURGERY
  • 2011-05. Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia in SURGICAL ENDOSCOPY
  • 2014-06. Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer in SURGICAL ENDOSCOPY
  • 2018-03. Internal hernia after proximal gastrectomy with jejunal interposition in UPDATES IN SURGERY
  • 2015-12. Petersen hernia after open gastrectomy with Roux-en-Y reconstruction: a report of two cases and literature review in SPRINGERPLUS
  • 2013-03. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics in BONE MARROW TRANSPLANTATION
  • Journal

    TITLE

    Surgical Endoscopy

    ISSUE

    N/A

    VOLUME

    N/A

    Author Affiliations

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00464-019-06787-x

    DOI

    http://dx.doi.org/10.1007/s00464-019-06787-x

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1113300995

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30963263


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    31 schema:description BACKGROUND: Internal hernia (IH) is a life-threatening complication after gastrectomy. The increase in the frequency of minimally invasive surgery is considered to be related to the increase in the frequency of IH, and mesenteric defect closure has been recommended to reduce this complication. However, IH can occur even when mesenteric defects are closed, so the risk of IH in the patients with mesenteric closure remains uncertain. We attempted to clarify the risk factors for IH in these patients. METHODS: From 2013 to 2017, we retrospectively reviewed 310 patients with gastric cancer who underwent laparoscopic or robot-assisted gastrectomy with Roux-en-Y (RY) or double-tract (DT) reconstruction with mesenteric defect closure. Univariate and multivariate analyses were performed to identify the risk factors. RESULTS: The incidence of IH was 1.3% (n = 4). A preoperative body mass index (BMI) ≥ 25 kg/m2 (p = 0.044), postoperative chemotherapy (p = 0.034), and body weight loss rate at 6 months ≥ 15% (p = 0.045) were risk factors for IH on a univariate analysis. A multivariate analysis showed that a BMI at the time of surgery of ≥ 25 kg/m2 was an independent risk factor for IH (odds ratio = 11.9, p = 0.049). CONCLUSIONS: Preoperative obesity is an independent risk factor for IH after minimally invasive gastrectomy followed by RY or DT reconstruction with mesenteric defect closure. We need to conduct vigilant follow-up for IH, especially in these patients.
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