Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

Abstract

Background To decrease the incidence of internal hernia after laparoscopic Roux-en-Y gastric bypass, recent recommendations indicated closure of mesenteric defects and Petersen's defect. Laparoscopic distal gastrectomy for gastric cancer is used increasingly, so the incidence of Petersen's hernia can also increase, but the trend has not been studied. Methods This study retrospectively reviewed 358 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer at one institution, with antecolic Roux-en-Y (RY) reconstruction. Results Petersen's hernia occurred in 6 (2.2 %) of 268 patients whose Petersen's defect was not closed by a mean of 351 days after surgery. All the patients underwent reoperation with reduction and repair of the hernia except the first case. In 90 subsequent cases, with closure of the Petersen's defect, internal hernias did not occur (0/90 cases; p = 0.06). Focusing on the totally laparoscopic procedure, Petersen's hernia occurred in 2 (5.1 %) of 39 patients, whereas in 81 subsequent cases, with closure of Petersen's defect, internal hernias did not occur (0/81 cases; p = 0.03). Conclusions Based on the recent recommendations for bariatric surgery, closure of this potential hernia defect is necessary after laparoscopic distal gastrectomy with R-Y reconstruction for gastric cancer.

Petersen's Hernia after Esophagectomy With Antesternal Jejunal Reconstruction: Case Report

“…To minimize the occurrence of internal hernia, closure of the jejunojejunal mesenteric defect and Petersen's defect with continuous nonabsorbable sutures is recommended when performing laparoscopic distal gastrectomy and R-Y reconstruction, which is consistent with the recommendations for laparoscopic RYGBP with antecolic R-Y reconstruction [9]. Weight loss after esophagectomy was 9.3 % of preoperative body weight.…”

Dual incarcerated internal hernias after laparoscopic total gastrectomy with Roux-en-Y reconstruction for gastric cancer

“…Some studies have demonstrated lower occurrence of internal hernia after a switch in practice by closing the defects (table 2). 1 2 4 A large Japanese study revealed a significant reduction in incidence of internal hernia (jejunojejunostomy mesenteric defect; 0% vs 3.4%, p=0.01) and a similar trend in Petersen's defect 2. In Miyagaki et al 's series,6 they do not close Petersen's space and opinioned that if the orifice is not closed, it should be left large to allow transposition of small bowel and avoid incarceration.…”

Mortality due to Internal Herniation As A Late Complication in A Patient who Underwent Laparoscopic Total Gastrectomy for Early Gastric Cancer

“…Following Roux-en-Y reconstruction, Petersen's spaces, jejuna-jejunal spaces, and transverse mesocolon spaces (if anastomosis was performed retrocolic) was formed. The herniation of intestinal structures through such spaces may lead to intestinal obstruction, ischemia, or necrosis (3)(4)(5)(6).…”

“…The reasons for this situation include the decrease in mesenteric fat tissue because of postoperative weight loss, lesser amount of adhesions following laparoscopic surgery, leaving a longer Roux limb, and the . Internal herniation after laparoscopic gastric resection can be seen at any time after surgery, but the prevalence increases after the first year (1,4,5). In a study by Kelly et al (3), the authors stated that the rate of internal herniation following laparoscopic total gastrectomy was 22% at the end of an average of 22.4-month follow-up period.…”

“…Almost half of the internal herniation cases are based on the occurrence of this space. Herniation cases can be prevented by closing the Petersen's and jejuna-jejunal spaces (4)(5)(6). We hereby present the case of a patient who underwent laparoscopic total gastrectomy because of early-phase gastric cancer and who developed massive intestinal necrosis because of internal herniation in the third year of follow-up.…”