• antiadhesion membrane
• gastrectomy
• gastric cancer
• roux‐en‐Y reconstruction
• small bowel obstruction

• Japan Agency for Medical Research and Development

• Gastrectomy
• Gastric cancer
• Internal hernia
• Laparoscopy
• Petersen’s hernia

• Gastrectomy/adverse effects
• Gastric Bypass
• Hernia, Abdominal/surgery
• Humans
• Internal Hernia
• Laparoscopy
• Obesity, Morbid/surgery
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Retrospective Studies
• Stomach Neoplasms/surgery

• SZYJTD201804 the gastrointestinal oncology international team cooperation project

Petersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions.

Data from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation.

A total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p < 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041).

Low BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.

• Petersen’s hernia
• gastrectomy
• gastric cancer
• internal hernia
• risk factor

• complications
• gastric cancer
• radical gastrectomy
• reoperation
• risk factors

Internal hernia after gastrectomy is a rare but potentially life-threatening condition without surgical intervention. Clinical risk factors of internal hernia should, hence, be reviewed after gastrectomy. From 2008 to 2018, patients who underwent gastrectomy for gastric cancer were investigated.

Abdominal computed tomography (CT) was used to screen for internal hernia, and surgical exploration was performed to confirm the diagnosis. Using retrospective statistical analysis, the incidence, characteristics, and risk factors were identified, and the characteristics of the internal hernia group were reviewed.

The overall incidence of internal hernia was 0.9%. From statistical analysis, it was found that laparoscopic surgery was almost five times riskier than open gastrectomy (odds ratio [OR], 4.947; 95% confidence interval [CI], 1.308–18.710; p = 0.019). Body mass index < 25 kg/m² (OR, 4.596; 95% CI, 1.056–20.004; p = 0.042) and proximal gastrectomy (OR, 4.238; 95% CI, 1.072–16.751; p = 0.039) were also associated with internal hernia. Among 20 patients with internal hernia, 12 underwent laparotomy, and five had their bowels removed due to ischemia. All patients with bowel resected had suffered from short bowel syndrome.

Suspecting an internal hernia should be an important step when a patient with a history of laparoscopic gastrectomy visits for medical care. When suspected, emergent screening through CT scan and surgical intervention should be considered as soon as possible to prevent lifetime complications accordingly.

• Emergency surgery
• Esophagectomy
• Gastrectomy
• Hiatal hernia repair
• Trans-hiatal hernia
• Trans-hiatal herniation

• Gastrectomy
• Gastric cancer
• Petersen’s hernia

• Anastomosis, Roux-en-Y
• China/epidemiology
• Gastrectomy/adverse effects
• Gastric Bypass
• Hernia, Abdominal/surgery
• Humans
• Interrupted Time Series Analysis
• Laparoscopy
• Retrospective Studies
• Stomach Neoplasms/surgery

• 81702366 National Natural Science Foundation of China
• 2019YFS0255 Foundation of Science & Technology Department of Sichuan Province
• ZY2017304 State Key Laboratory of Architectural Science and Technology in West China (CN)
• 2017-114 Sichuan Mineral Resources Research Center (CN)
• Foundation of Science & Technology Department of Sichuan Province

• Petersen’s hernia
• bariatric surgery
• gastric neoplasm
• hernia
• laparoscopy

Laparoscopic distal gastrectomy (LDG) for gastric cancer has been progressed and popular in Japan, since it was first described in 1994. Several reconstruction methods can be adopted according to remnant stomach size, and balance of pros and cons. Roux-en-Y (R-Y) reconstruction is a one of standard options after LDG. Its complications include Petersen’s hernia and Roux stasis syndrome. Here we report our ingenious attempt, fixation of Roux limb and duodenal stump, for decreasing the development of Petersen’s hernia and Roux stasis syndrome.

To develop a method to decrease the development of Petersen’s hernia and Roux stasis syndrome.

We performed ante-colic R-Y reconstruction after LDG. After R-Y reconstruction, we fixed Roux limb onto the duodenal stump in a smooth radian. Via this small improvement in Roux limb, Roux limb was placed to the right of the ligament of Treitz. This not only changed the anatomy of the Petersen’s defect, but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy. 31 patients with gastric cancer was performed this technique after R-Y reconstruction. Clinical parameters including clinicopathologic characteristics, perioperative outcomes, postoperative complication and follow-up data were evaluated.

The operative time was (308.0 ± 84.6 min). This improvement method took about 10 min. Two (6.5%) patients experienced pneumonia and pancreatitis, respectively. No patient required reoperation or readmission. All patients were followed up for at least 3 year, and none of the patients developed postoperative complications related to internal hernia or Roux stasis syndrome.

This 10 min technique is a very effective method to decrease the development of Petersen’s hernia and Roux stasis syndrome in patients who undergo LDG.

• Laparoscopy distal gastrectomy
• Roux-en-Y reconstruction
• Internal hernia
• Roux limb syndrome
• Gastric cancer

• Gastric cancer
• Internal hernia
• Laparoscopic gastrectomy
• Risk factor
• Robot-assisted gastrectomy