Internal hernia after laparoscopic total gastrectomy with Roux-en-Y reconstruction

Abstract

Laparoscopic total gastrectomy is a less invasive and feasible treatment compared with conventional open surgery. Roux-en-Y reconstruction has been reported to be a safe and effective method. Although much less postoperative adhesion is one of the advantages of laparoscopic surgery, this is also responsible for a higher incidence of internal hernias. This is a case report of two patients with internal hernia after laparoscopic total gastrectomy with Roux-en-Y reconstruction. A 76-year-old man was given a diagnosis of internal hernia with strangulation ileus after total gastrectomy with Roux-en-Y reconstruction. He was admitted to our hospital with an acute abdominal pain in his left upper abdomen. CT scan imaging indicated the presence of strangulation ileus in jejunojejunostomy mesenteric defect. Thus, internal hernia with strangulation ileus was diagnosed. We performed a laparotomic repair of internal hernia and strangulation ileus. A 74-year-old man was given a diagnosis of subileus after total gastrectomy with Roux-en-Y reconstruction. He was admitted to our hospital with repeated episodes of abdominal pain. CT scan imaging did not indicate the presence of incarceration. We performed an exploratory laparoscopy and found incarcerated ileum through the Petersen's defect. To prevent perforation of incarcerated ileum, we converted to open surgery for repair of internal hernia and strangulation ileus. Prevention of internal hernia by surgical techniques and prompt diagnosis including laparoscopy are the key to minimizing the risk of morbidity of internal hernia and bowel infarction. © 2012 The Japanese Society of Gastroenterological Surgery.