1
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Liu YL, Liu WC. Preservation of superior rectal artery in laparoscopic colectomy: The best choice for slow transit constipation? World J Gastrointest Surg 2024; 16:2362-2364. [PMID: 39087113 PMCID: PMC11287701 DOI: 10.4240/wjgs.v16.i7.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/18/2024] [Accepted: 07/03/2024] [Indexed: 07/22/2024] Open
Abstract
Laparoscopic colectomy with ileorectal anastomosis may be beneficial for patients with slow transit constipation who do not respond to conservative treatment, particularly if the superior rectal artery (SRA) is preserved. Several important concerns have been addressed in this commentary. It is important to first go over the definition of surgical procedure as it is used in this text. Second, the current study lacked a control group that had SRA preservation. Thirdly, it would be best to use a prospective, randomized controlled study. Lastly, a description of the mesenteric defect's state following a laparoscopic colectomy is necessary.
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Affiliation(s)
- Yi-Lei Liu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200003, China
| | - Wei-Cheng Liu
- Department of Colorectal and Anal Surgery (Clinical Center for Pelvic Floor Surgery), Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
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2
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Kaneko Y, Strugnell N, Pham T. Large bowel obstruction caused by a small bowel internal hernia. ANZ J Surg 2024. [PMID: 39041584 DOI: 10.1111/ans.19162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/05/2024] [Accepted: 06/30/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Yui Kaneko
- Division of General Surgery, Colorectal Unit, The Northern Hospital, Melbourne, Victoria, Australia
| | - Neil Strugnell
- Division of General Surgery, Colorectal Unit, The Northern Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Toan Pham
- Division of General Surgery, Colorectal Unit, The Northern Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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3
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Costi R, Amato A, Annicchiarico A, Montali F, Binda GA. Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR). Updates Surg 2024:10.1007/s13304-024-01927-y. [PMID: 39044095 DOI: 10.1007/s13304-024-01927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024]
Abstract
Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula.
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Affiliation(s)
- Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Antonio Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, IM, Italy
| | - Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Department of General Surgery, Vaio Hospital, Fidenza, Italy.
| | - Filippo Montali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
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Luo W, Li F, Qian C, Lu T, Xiao Y, Xu Z, Jia Y. A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer. BMC Surg 2024; 24:202. [PMID: 38965517 PMCID: PMC11223325 DOI: 10.1186/s12893-024-02492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/25/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential "hernia ring," increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue. METHODS This new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the "hernia ring" to preserve the connective tissue between the "hernia ring" and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending colon was mobilized cephalad. Patients'preoperative baseline characteristics and intraoperative, postoperative complications were examined. RESULTS All patients' potential "hernia rings" were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30-90). The total harvested lymph nodes was 13.0(range12-19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed. CONCLUSIONS This technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.
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Affiliation(s)
- Wenjun Luo
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China.
| | - Fugen Li
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Chuan Qian
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Tingting Lu
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Yanling Xiao
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Zhengwen Xu
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Yingdong Jia
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
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Kotohata Y, Yaegashi M, Sasaki N, Sasaki A. Rare strangulated intenal hernia following extraperitoneal colostomy for rectal cancer operation: A case report. Int J Surg Case Rep 2024; 120:109911. [PMID: 38880000 PMCID: PMC11228626 DOI: 10.1016/j.ijscr.2024.109911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Few cases of intestinal obstruction after colostomy are caused by internal hernia. Some institutions perform stomas through the extraperitoneal route because some patients experience an internal hernia outside the stoma performed through the intraperitoneal route. PRESENTATION OF CASE A 72-year-old woman presented with a history of laparoscopic abdominoperineal resection (APR). A sigmoid colostomy was performed via the extraperitoneal route during APR. One month after APR, the patient presented to the emergency department of our hospital with abdominal pain and vomiting. Computed tomography revealed that the small intestine had passed through the extraperitoneal tunnel, resulting in strangulated intestinal obstruction, and emergency laparotomy was performed. During surgery, the ileum passed behind the elevated sigmoid colon in a caudal-to-cranial direction and formed an unusual closed loop. The strangulated part of the small intestine showed ischemic change; however, the intestine quickly normalized soon after strangulation was released, and the operation was completed without resection of the intestine. DISCUSSION The major cause of intestinal obstruction after colostomy is intraperitoneal adhesion. Looseness of the elevated sigmoid colon can cause internal hernia, if under pneumoperitoneum, when a colostomy is created through the extraperitoneal route in laparoscopic APR. Furthermore, the patient had lost more than 5 kg of body weight after the surgery, which may have led to the looseness of the elevated sigmoid colon. CONCLUSION Releasing the pneumoperitoneum during the elevation of the sigmoid colon is necessary to prevent internal hernia, even with a colostomy performed through the extraperitoneal route.1.
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Affiliation(s)
- Yosuke Kotohata
- Department of Surgery, Iwate Medical University School of Medicine, Shiwa, Japan.
| | - Mizunori Yaegashi
- Department of Surgery, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Noriyuki Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Shiwa, Japan
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Golden E, Brookmeyer C, Gomez E. Don't be thrown for a loop: a review of internal hernias for the abdominal imager. Abdom Radiol (NY) 2024:10.1007/s00261-024-04426-1. [PMID: 38916615 DOI: 10.1007/s00261-024-04426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024]
Abstract
Internal hernias are herniations of abdominal viscera, usually small bowel, through congenital or acquired openings of the peritoneum or mesentery. Congenital hernias may involve anatomic fossae such as the epiploic foramen as well as those related to abnormal peritoneal or mesenteric defects; these include left and right paraduodenal, transomental, transmesenteric, pericecal and broad ligament hernias. Acquired hernias are due to defects in the mesentery or peritoneum, usually resulting from prior surgeries, and include those associated with Roux-en-Y surgery as well as colorectal cancer resections. Internal hernias account for 5.8% of small obstructions. Obstructed internal hernias are considered surgical emergencies due to the high risk of bowel strangulation. This review summarizes the various types of congenital and acquired internal hernias, their relevant anatomy, embryology, associated surgical history and imaging appearance. We will also discuss a location-based approach to identifying internal hernias on CT, as well as complications and relevant signs, of which abdominal imagers should be vigilant.
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Affiliation(s)
- Edwarda Golden
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD, 21287, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Claire Brookmeyer
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD, 21287, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD, 21287, USA
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7
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Feng D, Kondo A, Asano E, Matsukawa H, Nishiura B, Ando Y, Suto H, Kishino T, Oshima M, Kumamoto K, Okano K. Internal hernia after laparoscopic sigmoidectomy with splenic flexural mobilization and high ligation of the inferior mesenteric vein: A case report. Asian J Endosc Surg 2023. [PMID: 37186421 DOI: 10.1111/ases.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Several studies have recently reported the rare occurrence of internal herniation of the small bowel after laparoscopic colorectal surgery. Most cases of internal herniation after laparoscopic colorectal surgery occur due to a mesenteric defect. However, there have been no reports on the indications for closing mesenteric defects to prevent the development of an internal hernia. This study reports a case of an internal hernia of the proximal jejunum near the ligament of Treitz in a patient who underwent laparoscopic sigmoidectomy with splenic flexural mobilization and high ligation of the inferior mesenteric vein. Assessing the risk for internal herniation before completing the initial surgery is crucial. Additionally, mesenteric defect closure should be performed to prevent the development of internal hernias among patients with a potential risk.
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Affiliation(s)
- Dongping Feng
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akihiro Kondo
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Eisuke Asano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroyuki Matsukawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Bumpei Nishiura
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasuhisa Ando
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hironobu Suto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takayoshi Kishino
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Minoru Oshima
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kensuke Kumamoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
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8
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Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications. J Clin Med 2023; 12:jcm12041489. [PMID: 36836024 PMCID: PMC9966470 DOI: 10.3390/jcm12041489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Rectal cancer (RC) is one of the deadliest malignancies worldwide. Surgery is the most common treatment for RC, performed in 63.2% of patients. The type of surgical approach chosen aims to achieve maximum residual function with the lowest risk of recurrence. The selection is made by a multidisciplinary team that assesses the characteristics of the patient and the tumor. Total mesorectal excision (TME), including both low anterior resection (LAR) and abdominoperineal resection (APR), is still the standard of care for RC. Radical surgery is burdened by a 31% rate of major complications (Clavien-Dindo grade 3-4), such as anastomotic leaks and a risk of a permanent stoma. In recent years, less-invasive techniques, such as local excision, have been tested. These additional procedures could mitigate the morbidity of rectal resection, while providing acceptable oncologic results. The "watch and wait" approach is not a globally accepted model of care but encouraging results on selected groups of patients make it a promising strategy. In this plethora of treatments, the radiologist is called upon to distinguish a physiological from a pathological postoperative finding. The aim of this narrative review is to identify the main post-surgical complications and the most effective imaging techniques.
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9
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Tueme-de la Peña D, Acosta-Flores JA, Garza-Cantú AA, Rangel-Ríos HA, Chapa-Lobo AF, Salgado-Cruz LE. Internal Hernia After Laparoscopic Left Colectomy: Case Series and Review of the Literature. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0042-1759608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Objective Laparoscopic colectomy has gained acceptance as a standard treatment for benign and malignant colorectal disease, such as diverticular disease and cancer, among others. Same as in open surgery, the laparoscopic approach carries a low risk of small bowel obstruction in the postoperative period, but in laparoscopic surgery, internal hernia after laparoscopic left colectomy may be a cause of small bowel obstruction with a significant risk of morbidity and mortality. This rare complication may be prevented with routine closure of the mesenteric defects created during the colectomy.
Methods We present four cases of internal herniation after laparoscopic colectomy. Two cases were after laparoscopic left colectomy and two after laparoscopic low anterior resection. All four cases had full splenic flexure mobilization. Routine closure of the mesenteric defect was not performed in the initial surgery.
Results The four patients were treated by laparoscopic reintervention with closure of the mesenteric defect. In two of them, conversion to open surgery was necessary. One of the patients developed recurrent internal herniation after surgical reintervention with mesenteric closure of the defect. All patients were managed without need for bowel resection, and mortality rate was 0%.
Conclusion Internal herniation after laparoscopic colorectal surgery is a highly morbid complication that requires prompt diagnosis and management and should be suspected in the early postoperative period. Additional studies with extended follow-up are required to establish recommendations regarding its prevention and management.
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Affiliation(s)
- Danilo Tueme-de la Peña
- Department of Surgery, Division of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, México
| | - José Adolfo Acosta-Flores
- Department of General Surgery, Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - Alan Alejandro Garza-Cantú
- Department of Surgery, Division of Coloproctology, Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, México
| | - Hugo Antonio Rangel-Ríos
- Department of Surgery, Division of Coloproctology, Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, México
| | - Alberto Félix Chapa-Lobo
- Department of Surgery, Division of Coloproctology, Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, México
| | - Luis Enrique Salgado-Cruz
- Department of General Surgery, Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Monterrey, Nuevo León, México
- Department of Surgery, Division of Coloproctology, Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, México
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10
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Tada Y, Orihara J, Wada Y, Uchinaka E, Osaki T, Ashida K, Tatebe S, Kuroda S, Hirooka Y. Post-colostomy internal hernia of the stomach treated with laparoscopic gastropexy: a case report. Surg Case Rep 2022; 8:105. [PMID: 35644826 PMCID: PMC9148867 DOI: 10.1186/s40792-022-01455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Internal hernias are formed by the protrusion of internal organs through an aperture formed congenitally or postoperatively. Internal hernias are most commonly associated with the small intestine. Only two cases of a post-sigmoid colostomy internal hernia of the stomach have been reported. This hernia arises from the space between the lifted sigmoid colon and the left abdominal wall. In the two aforementioned cases, treatment comprised suturing of the sigmoid colon to the lateral abdominal wall and changing of the intraperitoneal route to an extraperitoneal one. Herein, we present a very rare case who underwent laparoscopic gastropexy for a post-sigmoid colostomy internal hernia of the stomach.
Case presentation
Our patient, a 67-year-old woman, was undergoing chemoradiation for rectal cancer and planned to undergo abdominoperineal resection. However, tumor perforation resulted in a high fever and a right gluteal abscess; therefore, a sigmoid colostomy was performed through the intraperitoneal route in the left lower abdomen. One month after the surgery, the patient presented to our emergency room with vomiting, abdominal pain, and abdominal distension. Computed tomography revealed a markedly distended stomach caused by the obstruction of the pylorus secondary to the colostomy; laparoscopic gastropexy was performed subsequently and the postoperative course was uneventful.
Conclusions
This is the first report on the laparoscopic gastropexy treatment of a post-sigmoid colostomy internal hernia of the stomach; our findings may help physicians manage such hernias.
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11
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Portale G, Pedon S, Rettore C, Cipollari C, Zuin M, Spolverato Y, Cancian L, Fiscon V. Internal hernia following laparoscopic anterior resection for cancer: higher prevalence than expected of an under-reported complication. Int J Colorectal Dis 2022; 37:331-335. [PMID: 34766204 DOI: 10.1007/s00384-021-04044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Internal hernia (IH) after laparoscopic colorectal surgery is a potentially severe complication. It may go undiagnosed in patients having their abdominal CT scan during oncologic follow-up. We evaluated the occurrence of IH on CT scans after laparoscopic curative resection for rectal cancer (LRRC) and routine closure of the mesenteric defect. METHODS Data from 189 consecutive patients undergoing elective curative LRRC in a 14-year period (June 2005-june 2019) were prospectively collected. Only patients with abdominal CT scans, performed as routine oncologic follow-up, between 3 months and 7 years post-operatively were included in the study and reviewed by a surgeon and a radiologist. RESULTS A total of 161 patients were eligible for the study with a median age of 69 years (IQR: 59-77) at surgery. They had abdominal follow-up CT scans at a median of 39.5 months (IQR: 12.8-62.7) after surgery. The prevalence of IH was 11.2% (18/161 patients). Of the 18 patients, 15 (83.3%) were fully asymptomatic, 2 (11.1%) reported chronic abdominal discomfort (including mostly nausea and colicky pain) during their oncologic follow-up (however, IH was not suspected neither prompted additional investigations), and 1 (5.6%) was reoperated elsewhere for IH and acute small bowel obstruction. CONCLUSIONS IH following LRRC is not uncommon, with a prevalence > 10% in our experience. Most of these patients remain fully asymptomatic, but in a few patients, IH might be responsible for some symptoms or require reoperation. Awareness of this complication is important, given the potential risk of acute small bowel obstruction.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy.
| | - Sabrina Pedon
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Carlo Rettore
- Department of Radiology, ULSS 6 Euganea, Cittadella, Italy
| | - Chiara Cipollari
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Matteo Zuin
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Ylenia Spolverato
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Luca Cancian
- Department of Radiology, ULSS 6 Euganea, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
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12
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Peltrini R, Pirozzi N, Ilardi M, Bracale U, Corcione F. Laparoscopic repair of internal hernia with late presentation and primary closure of the mesocolic defect - a video vignette. Colorectal Dis 2021; 23:2207-2208. [PMID: 33998124 DOI: 10.1111/codi.15736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Roberto Peltrini
- Department of Public Health, School of Medicine, University of Naples 'Federico II', Naples, Italy
| | - Nello Pirozzi
- Department of Public Health, School of Medicine, University of Naples 'Federico II', Naples, Italy
| | - Mariangela Ilardi
- Department of Public Health, School of Medicine, University of Naples 'Federico II', Naples, Italy
| | - Umberto Bracale
- Department of Public Health, School of Medicine, University of Naples 'Federico II', Naples, Italy
| | - Francesco Corcione
- Department of Public Health, School of Medicine, University of Naples 'Federico II', Naples, Italy
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13
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Pallan A, Dedelaite M, Mirajkar N, Newman PA, Plowright J, Ashraf S. Postoperative complications of colorectal cancer. Clin Radiol 2021; 76:896-907. [PMID: 34281707 DOI: 10.1016/j.crad.2021.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
Colorectal cancer is the third most common cancer, and surgery is the most common treatment. Several surgical options are available, but each is associated with a range of potential complications. The timely and efficient identification of these complications is vital for effective clinical management of these patients in order to minimise their morbidity and mortality. This review aims to describe the range of commonly performed surgical treatments for colorectal surgery. In addition, frequent post-surgical complications are explored with investigative options explained and illustrated.
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Affiliation(s)
- A Pallan
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - M Dedelaite
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - N Mirajkar
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P A Newman
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Plowright
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - S Ashraf
- Department of Colorectal Surgery, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
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Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn's disease. Tech Coloproctol 2021; 25:1079-1084. [PMID: 34268652 DOI: 10.1007/s10151-021-02493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
Mesenteric closure following right colectomy remains controversial and, following the advent of laparoscopic surgery, many surgeons do not routinely close the mesentery after colorectal resection. Nevertheless, especially after the introduction of operations such as right colectomy with complete mesocolic excision and ileocolic resections with extensive mesentery removal for Crohn's disease, the wide mesenteric defect resulting from the dissections can certainly expose the patients to complications such as internal hernias or volvuli. In general, mesenteric closure requires intracorporeal suturing. We describe a simple technique for the closure of the mesentery after surgical resection using polymer-ligating clips. This novel technique seems to minimize the time, effort and risk inherent to the procedure, even after large mesenteric excisions.
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Nitta T, Ebihara Y, Hirano S. Postoperative Outcomes of Closed Versus Nonclosed Mesentery Laparoscopic Colectomy: A Retrospective Single-center Study. Surg Laparosc Endosc Percutan Tech 2021; 31:703-706. [PMID: 34166327 DOI: 10.1097/sle.0000000000000967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to clarify the clinical significance of closing the mesenteric defect in laparoscopic colectomy. MATERIALS AND METHODS We retrospectively evaluated 369 patients who underwent left-sided or right-sided resection via laparoscopic colectomy at our institute. Patients were stratified by open versus closed handling of the mesenteric defect. The perioperative clinical factors, surgical maneuvers, and postoperative complications were statistically analyzed. RESULTS No significant intergroup differences were found in the perioperative clinical factors or surgical maneuvers except for number of days to the first soft diet (P=0.0214) and postoperative complications (P=0.0379). Among the postoperative complications, only ileus occurred more frequently in the closed group than in the open group (P=0.0227). CONCLUSIONS This study revealed that closure of the mesenteric defect following laparoscopic colectomy might be associated with an increased incidence of postoperative ileus.
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Affiliation(s)
- Takeo Nitta
- Departnent of Gastroenterological Surgery, Kitami Red Cross Hospital, Kitami, Hokkaido
- Department of Gastroenterological Surgery II, Hokkaido, Faculty of Medicine, University, Kita-ku, Sapporo, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido, Faculty of Medicine, University, Kita-ku, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido, Faculty of Medicine, University, Kita-ku, Sapporo, Japan
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Huynh R, Reece M, Mansouri D, Nguyen TM, Keshava A. Laparoscopic colopexy for neo-left colonic volvulus 10 years after anterior resection. J Surg Case Rep 2020; 2020:rjaa555. [PMID: 33425325 PMCID: PMC7778506 DOI: 10.1093/jscr/rjaa555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Recurrent neo-left colonic volvulus is a rare complication following anterior resection. The conventional approach to treating recurrent volvulus is a large bowel resection with anastomosis or colostomy formation after successful endoscopic decompression. However, in elderly and comorbid patients, this can result in significant morbidity or mortality. Laparoscopic colopexy is a less invasive alternative that has not been previously reported for the treatment of neo-left colonic volvulus. We describe a case of an 86-year-old male who presented with recurrent neo-left colonic volvulus 10 years post-laparoscopic anterior resection for cancer. A laparoscopic colopexy was performed to resolve the volvulus and prevent future recurrence. Interrupted prolene sutures were used to fix the neo-left colon to the posterior stomach and the left lateral abdominal wall. The patient had an uncomplicated postoperative recovery and was discharged 6 days after surgery. He was well at 6 months follow-up.
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Affiliation(s)
- Roy Huynh
- Department of Colorectal Surgery, University of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Mifanwy Reece
- Department of Colorectal Surgery, University of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - David Mansouri
- Department of Colorectal Surgery, University of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Thuy-My Nguyen
- Department of Colorectal Surgery, University of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Anil Keshava
- Department of Colorectal Surgery, University of Sydney, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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17
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Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients. Surg Endosc 2020; 35:4315-4320. [DOI: 10.1007/s00464-020-07921-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/17/2020] [Indexed: 01/05/2023]
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18
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Hashida H, Kita R, Kondo M, Mizuno R, Kobayashi H, Kaihara S. Internal hernia of the stomach associated with colostomy after laparoscopic surgery for rectal cancer: a case report. Surg Case Rep 2020; 6:127. [PMID: 32495102 PMCID: PMC7270322 DOI: 10.1186/s40792-020-00889-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background Colostomy via the intraperitoneal route is often performed during laparoscopic Hartmann’s operation or abdominoperineal resection. Internal hernia of the small intestine often occurs after colostomy. This report shows a rare case of internal hernia of the stomach associated with sigmoid colostomy after laparoscopic abdominoperineal resection for rectal cancer. Case presentation The patient was a 79-year-old woman with a sigmoid colostomy. Computed tomography scan showed a markedly distended stomach in the space between the lifted sigmoid colon and the lateral abdominal wall. Laparoscopy revealed that the body of the stomach had passed through a hernia orifice located between the lifted sigmoid colon and the left lateral abdominal wall. The dislocated stomach was restored to its normal position, and the lateral defect was closed with the lateral peritoneum and the lifted sigmoid colon laparoscopically. Conclusions Internal hernia associated with colostomy can lead to not only obstruction of the small intestine, but also obstruction of the stomach. We reported a successful case of the suture repair for the internal hernia of the stomach associated with colostomy.
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Affiliation(s)
- Hiroki Hashida
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Ryosuke Kita
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Ryosuke Mizuno
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Laparoscopic treatment of internal hernia following minimally invasive left hemicolectomy. Tech Coloproctol 2020; 24:1089. [PMID: 32444950 DOI: 10.1007/s10151-020-02233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
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20
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Moritz C, Scheiwe C, Malgras B. Colonic volvulus after laparoscopic left colectomy. J Visc Surg 2020; 157:493-494. [PMID: 32389393 DOI: 10.1016/j.jviscsurg.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Volvulus of the mobilized colon after laparoscopic left colectomy is rare. Contributing factors seem to be excessive length of the mobilized colon, absence of peritonization and absence of adhesions due to laparoscopy. Onset of colonic volvulus after laparoscopic left colectomy should lead to routine computerized tomography (CT), searching for an image suggestive of small intestinal incarceration under the neo-mesocolon, which might be an additional risk factor. Treatment consists of disincarceration of the small intestines while closing the mesocolic defect remains a subject of controversy.
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Affiliation(s)
- C Moritz
- Department of digestive and endocrine surgery, Bégin Army training hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - C Scheiwe
- Department of digestive and endocrine surgery, Bégin Army training hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - B Malgras
- Department of digestive and endocrine surgery, Bégin Army training hospital, 69, avenue de Paris, 94160 Saint-Mandé, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.
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High prevalence of asymptomatic internal hernias after laparoscopic anterior resection in a retrospective analysis of postoperative computed tomography. Int J Colorectal Dis 2020; 35:929-932. [PMID: 32095872 DOI: 10.1007/s00384-020-03537-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Internal hernia (IH) after laparoscopic left-sided colorectal resection (small bowel herniating underneath the neo-descending colon) can be a potentially devastating complication, resulting in acute small bowel obstruction or ischemia. IH has been described as a rare occurrence in a few retrospective case series; however, patients undergoing laparoscopic resection seem to be more prone to this complication. We assessed the prevalence of IH in a large cohort of patients who had undergone laparoscopic left-sided colorectal resection for colon or rectal cancer (CRC). METHODS A database of consecutive patients at a single institution from 2012 to 2017 was reviewed. Postoperative abdominal computed tomography (CT) scans performed for routine cancer follow-up between 3 and 36 months after surgery were assessed retrospectively. RESULTS During the study period, 276 patients had undergone anterior resection for CRC, with 206 (75%) having been performed laparoscopically. A total of 198 eligible patients were identified, and a follow-up CT scan was available in 105 (53%) of these patients (median time to CT 10 months, range 3-34). Only one of the 198 (0.5%) patients presented with an acute small bowel obstruction secondary to an IH during follow-up. However, the prevalence of asymptomatic IH was noted to be much higher in the postoperative CT scans occurring in 22 of 105 (21%) patients. CONCLUSION Asymptomatic IH after laparoscopic left-sided colorectal resection is common. Given the potential risk of acute small bowel obstruction and ischemia, routine closure of the mesenteric defect should be considered.
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Development of transomental hernia shortly after laparoscopic colonic surgery: a case report. Surg Case Rep 2020; 6:8. [PMID: 31915947 PMCID: PMC6949329 DOI: 10.1186/s40792-020-0783-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background A transomental hernia is defined as bowel invagination into an abnormal hiatus of the omentum. It is a rare type of internal hernia that is sometimes lethal. We herein report a case of a transomental hernia developing shortly after laparoscopic sigmoidectomy. Case presentation A 71-year-old man underwent laparoscopic sigmoidectomy. He was admitted to our hospital because of abdominal pain and nausea on postoperative day 12. Laboratory investigation showed increased levels of inflammatory markers. Abdominal computed tomography showed a closed loop and mesenteric edema of the small intestine with ascites. We performed an emergency operation under the diagnosis of strangulated bowel obstruction. Operative findings showed internal herniation of strangulated ileal loops through a defect of the omentum with hemorrhagic ascites. The incarcerated small bowel was resected and reconstructed because the ischemic change was irreversible after the reduction. We partially resected the omentum that had formed the defect. The patient’s postoperative progress was good, and he was discharged on postoperative day 8. Conclusions Almost all internal hernias after intestinal surgery are mesenteric hernias; however, we should bear in mind that the more lethal transomental hernia is also possible. Therefore, immediate surgical exploration should be performed in a timely manner for internal hernias, especially for patients with early-onset symptoms after laparoscopic intestinal surgery.
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Oshiro KI, Koinuma K, Matsumiya M, Takami M, Inose S, Kurihara K, Horie H, Kawarai Lefor A, Sata N. Mesocolic hernia after laparoscopic transverse colectomy: A case report. Int J Surg Case Rep 2019; 66:136-138. [PMID: 31838433 PMCID: PMC6920246 DOI: 10.1016/j.ijscr.2019.11.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/03/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
Internal hernias following laparoscopic colorectal resections are very rare. A mesenteric defect of the left transverse colon might be at higher risk of an internal hernia on anatomic grounds. We believe that a defect in the left transverse mesocolon require closure regardless of its size.
Introduction Internal hernias are rare after laparoscopic colorectal resections. We report a patient with an internal hernia through a defect in the transverse mesocolon following laparoscopic resection. Presentation of case A 52-year-old male underwent laparoscopic colectomy for transverse colon cancer and had an unremarkable postoperative course. Thirty days postoperatively, he presented to the emergency room with sudden onset abdominal pain and vomiting. Enhanced abdominal computed tomography scan showed strangulated small intestine in the left upper abdomen. An internal hernia through the mesenteric defect created during the recent colon resection was suspected, and emergency laparotomy was performed. One hundred thirty cm of small intestine was found herniated through a mesenteric defect. After repositioning the ischemic-appearing intestine, a 5 cm defect in the transverse mesocolon was found which had not been closed during the previous laparoscopic operation. No intestinal resection was needed, and the mesenteric defect closed with non-absorbable sutures. The post-operative course was unremarkable except for paralytic ileus, which resolved without further intervention. Discussion The incidence of internal hernia through a mesenteric defect after laparoscopic colorectal resection is quite low. Therefore, routine closure of the mesenteric defect after laparoscopic colorectal resection is not required. However, a left sided defect in the transverse mesocolon might be at higher risk of causing an internal hernia on anatomic grounds. Conclusion We believe that mesenteric defects should be closed after laparoscopic resection of the left side of transverse colon, regardless of their size.
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Affiliation(s)
- Ken-Ichi Oshiro
- Department of Surgery, Shin-Oyama City Hospital, 2251-1, Oyama, Tochigi 323-0827, Japan
| | - Koji Koinuma
- Department of Surgery, Jichi Medical University, 3311-1, Shimotsuke, Tochigi 329-0498, Japan.
| | - Misaki Matsumiya
- Department of Surgery, Shin-Oyama City Hospital, 2251-1, Oyama, Tochigi 323-0827, Japan
| | - Mariko Takami
- Department of Surgery, Shin-Oyama City Hospital, 2251-1, Oyama, Tochigi 323-0827, Japan
| | - Satoshi Inose
- Department of Surgery, Shin-Oyama City Hospital, 2251-1, Oyama, Tochigi 323-0827, Japan
| | - Katsumi Kurihara
- Department of Surgery, Shin-Oyama City Hospital, 2251-1, Oyama, Tochigi 323-0827, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, 3311-1, Shimotsuke, Tochigi 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1, Shimotsuke, Tochigi 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1, Shimotsuke, Tochigi 329-0498, Japan
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Taira T, Murono K, Nozawa H, Hojo D, Kawai K, Hata K, Tanaka T, Ishihara S. A cross sectional study to investigate internal hernia post left-sided colectomy preserving superior rectal artery. Ann Med Surg (Lond) 2019; 48:124-128. [PMID: 31763040 PMCID: PMC6864359 DOI: 10.1016/j.amsu.2019.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background and Purpose: Intestinal obstruction caused by an internal hernia projecting through a mesenteric defect is a rare sequela of laparoscopic colectomy, as surgeons usually leave such defects open. In this study, we investigated cases of internal hernia after laparoscopic left-sided colectomy. Methods Data of 308 patients who underwent laparoscopic left hemicolectomy or sigmoidectomy at our institute between 2013 and 2018 were retrospectively reviewed. Patient characteristics and surgical variables were analyzed. The distance between the superior rectal artery (SRA) and abdominal aorta at the level of aortic bifurcation was measured using postoperative computed tomography in patients who underwent SRA-preserving colectomy. Results In all, 3 patients (0.97%), all of whom had undergone colostomy without anastomosis and with SRA preservation, developed internal hernia passing between the SRA and the aorta. The distance between the SRA and abdominal aorta in patients who underwent ostomy was significantly more than that in patients who underwent non-ostomy (10.6 mm vs. 4.7 mm, respectively, p < 0.001). Conclusions SRA preservation and stoma construction are potential risk factors for internal hernia after laparoscopic left-sided colectomy. Lifting of the SRA due to stoma construction possibly enlarges the space between the SRA and aorta. When colostomy is created, it is important to evaluate the space behind the SRA.
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Affiliation(s)
- Tetsuro Taira
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Hojo
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Closure of the retroperitoneal space in laparoscopic anterior resection with FLEXDEX™. Tech Coloproctol 2019; 23:1177-1178. [PMID: 31754978 DOI: 10.1007/s10151-019-02118-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/02/2019] [Indexed: 12/19/2022]
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Portale G, Popescu GO, Parotto M, Cavallin F. Internal hernia after laparoscopic colorectal surgery: an under-reported potentially severe complication. A systematic review and meta-analysis. Surg Endosc 2019; 33:1066-1074. [PMID: 30680656 DOI: 10.1007/s00464-019-06671-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Internal hernia following laparoscopic colorectal surgery is often under-reported. The aim of this review was to evaluate the occurrence rate of internal hernia following laparoscopic colorectal surgery, and to describe clinical presentation and management strategies. METHODS A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through April 2018. The review was conducted according to MOOSE guidelines. Quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed using a random effects model. Studies reporting data on internal hernia after laparoscopic colorectal surgery were included. RESULTS Ten observational studies with a total of 8453 patients were included. All included articles were non-comparative prospective or retrospective cohort studies with an average MINORS score of 8.3 (range 6-11). Summary estimate of proportion of patients developing internal hernia after laparoscopic colorectal resection was 0.5% (95% CI 0.3-0.8%). Heterogeneity was moderate (I2 46%, p = 0.03) and study size (> 1000 vs. <1000 patients) was found to have a significant contribution to heterogeneity (p = 0.002). Thirty patients (90.9%) required surgery, with 5 non-fatal and 3 fatal postoperative complications. Quality of some studies was limited; some patients were followed up for less than 1 year; primary surgical procedures included different laparoscopic approaches. CONCLUSIONS Occurrence rate of internal hernia after laparoscopic colorectal resection is around 5 per 1000 patients. Small-sized studies are likely to overestimate the occurrence of internal hernia. Need for reoperation is high with a substantial risk of mortality.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero 40, 35013, Cittadella, Padua, Italy.
| | - George Octavian Popescu
- Department of General and Visceral Surgery, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Matteo Parotto
- Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Yasukawa D, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Hori T. Internal Hernia Associated with Colostomy After Laparoscopic Surgery for Rectal Malignancy: A Report of 3 Thought-Provoking Cases. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1488-1494. [PMID: 30546005 PMCID: PMC6302771 DOI: 10.12659/ajcr.912676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Case series Patients: Male, 70 • Male, 75 • Male, 85 Final Diagnosis: Internal hernia Symptoms: Abdominal and/or epigastric pain Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan.,Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
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Long-Term Consequences of Nonclosure of Mesenteric Defects after Traditional Right Colectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9123912. [PMID: 30356463 PMCID: PMC6178510 DOI: 10.1155/2018/9123912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022]
Abstract
Background There are still discrepancies among general/colorectal surgeons regarding closure of mesenteric defect in scientific literature. This study aimed to assess the long-term consequences of nonclosure of the mesenteric defect after open right colectomy. Methods A 7-year retrospectively collected and continuous database revealed 212 consecutive patients who had undergone traditional right colectomy without closing the mesenteric defects at Kaohsiung Chung-Gung Memorial Hospital; all patients were operated by a single surgeon. Among these patients, 17 were excluded (those who died within 30 days after surgery or those who received an end ileostomy). The mean age of the 195 patients (58% men and 42% women) was 61.6 ± 12.6 years, and the follow-up period was 4.1 ± 2.8 years (interquartile range 0.09 ~ 10.4). Results Forty-four patients (22.5%) encountered intestinal obstruction. Nine (20.4%) required surgical intervention. The cause of intestinal obstruction was adhesion (n=1), ventral hernia (n=1), and cancer recurrence (n=7). Conservative treatment was successful in 35 patients. The intestinal obstruction group (n = 44) were similar to the no-intestinal obstruction group (n = 151) in terms of the following parameters: age, sex, previous abdominal surgery, indication for colectomy, and procedure related complications. Carcinomatosis was found to increase the incidence of intestinal obstruction. No patient developed intestinal obstruction because of the nonclosure of mesenteric defects after right colectomy. Conclusion This study suggested that routine procedure of closing the mesenteric defect after open right colectomy might not be beneficial. Additional studies with extended long-term follow-up periods are needed to confirm the benefits of the nonclosure.
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Rouleau-Fournier F, Drolet S, Bouchard A, Bouchard P. Internal hernia following laparoscopic low anterior resection: a serious complication often misdiagnosed. ANZ J Surg 2018; 89:E276-E277. [PMID: 29316153 DOI: 10.1111/ans.14346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sebastien Drolet
- Department of Surgery, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Alexandre Bouchard
- Department of Surgery, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Philippe Bouchard
- Department of Surgery, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
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Yamanaka T, Araki K, Hagiwara K, Ishii N, Tsukagoshi M, Igarashi T, Watanabe A, Kubo N, Kuwano H, Shirabe K. Internal Hernia into the Treitz Fossa after Pancreaticoduodenectomy. Case Rep Gastroenterol 2017; 11:643-646. [PMID: 29282385 PMCID: PMC5731168 DOI: 10.1159/000479309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/07/2017] [Indexed: 12/17/2022] Open
Abstract
The development of an internal hernia into the Treitz fossa after pancreaticoduodenectomy has not been previously reported. We herein present such a case with a brief review of the literature. A 43-year-old man who had undergone pancreaticoduodenectomy with reconstruction of the digestive tract by the Child method at our hospital 7 months previously presented with abdominal pain. Computed tomography showed intestinal ileus with formation of a small intestinal loop that was suspected to be an internal hernia. Intraoperatively, we found that the dilated small intestine had entered the upper side of the abdomen from the ligament of Treitz. We detached the intestine from the hernia and placed it in its normal position. The ligament of Treitz at the hernia orifice was closed with sutures. The patient remained in good health and was discharged from the hospital 18 days after the second operation. Suturing of the Treitz fossa at the time of pancreaticoduodenectomy may be important to prevent the formation of an internal hernia.
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Affiliation(s)
- Takahiro Yamanaka
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichiro Araki
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kei Hagiwara
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Norihiro Ishii
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mariko Tsukagoshi
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takamichi Igarashi
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Norio Kubo
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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Prevention of internal hernias and pelvic adhesions following laparoscopic left-sided colorectal resection: the role of fibrin sealant. Surg Endosc 2016; 31:3048-3055. [PMID: 28039651 DOI: 10.1007/s00464-016-5328-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopy has increasingly become the standard of care for patients who undergo colorectal surgery for both benign and malignant diseases. This growing experience has also resulted in more reports of postoperative complications from the minimally invasive approach to primary colorectal resection. Small bowel obstruction from internal hernias and pre-sacral adhesions is an uncommon but not negligible complication. However, there is little literature specific to this topic with recommendations for different methods to prevent it. We report our original technique of closing the mesenteric defect and covering the pre-sacral fascia by using fibrin sealant to prevent this complication. METHODS From January 2005 to December 2014, a total of 1079 patients underwent elective laparoscopic left colorectal resection (left hemicolectomy or anterior rectal resection) in our department. In the first 298 procedures, the mesenteric defect was left open, while in the following 781 procedures, it was closed using fibrin sealant with the aim of preventing postoperative small bowel obstruction. RESULTS Among the first 298 patients, three (1%) required reoperation for small bowel obstruction due to internal hernia (0.33%) or critical pre-sacral adhesions (0.66%). These complications did not occur in the subsequent series in which all 781 patients were treated with fibrin sealant prophylactic closure of the mesenteric defect. CONCLUSION In our experience, fibrin sealant closure of the mesenteric defect has demonstrated to be safe and effective in preventing postoperative small bowel obstruction that remains a complication both in open and in laparoscopic colorectal surgeries.
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