Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Incarcerated Hiatal Hernia with Perforation after Laparoscopic Total Gastrectomy with Roux-en-Y Reconstruction: a Case Report

  • Wang, Nai-Yu (Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital) ;
  • Tsai, Chung-Yu (Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital) ;
  • Liu, Yuan-Yuarn (Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital) ;
  • Chen, I-Shu (Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital) ;
  • Ho, Kai-Hung (Department of Surgery, Division of General Surgery, Kaohsiung Veterans General Hospital)
  • Received : 2018.09.20
  • Accepted : 2019.03.04
  • Published : 2019.03.31
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Abstract

The occurrence of hiatal hernia after total gastrectomy with Roux-en-Y reconstruction is rare. We report the case of a 76-year-old man who presented with dyspnea, vomiting, and fever around 8 days after total gastrectomy with Roux-en-Y reconstruction. Abdominal computed tomography revealed a hiatal hernia containing part of the small intestine in the left thoracic cavity. Emergent reduction and repair of the hiatal hernia were performed later. Operative findings revealed that the Roux limb was incarcerated in the left pleural cavity. Esophagojejunostomy leakage, perforation of the small intestine with transient ischemic change, and pyothorax were also found. Thus, feeding jejunostomy, thoracoscopic decortication, and diversion T-tube esophagostomy were performed. Considering that the main cause of hiatal hernia is blunt dissection with division of the phrenoesophageal membrane, approximating the crus with 1 or 2 figure-8 sutures, according to the size of the defect, to prevent the incidence of hiatal hernia after total gastrectomy may be performed.

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References

  1. Ghahremani GG. Internal abdominal hernias. Surg Clin North Am 1984;64:393-406. https://doi.org/10.1016/S0039-6109(16)43293-7
  2. Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T, et al. Recent trend of internal hernia occurrence after gastrectomy for gastric cancer. World J Surg 2012;36:851-857. https://doi.org/10.1007/s00268-012-1479-2
  3. Aoki M, Saka M, Morita S, Fukagawa T, Katai H. Afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction. World J Surg 2010;34:2389-2392. https://doi.org/10.1007/s00268-010-0602-5
  4. Gayer G, Barsuk D, Hertz M, Apter S, Zissin R. CT diagnosis of afferent loop syndrome. Clin Radiol 2002;57:835-839. https://doi.org/10.1053/crad.2002.0972
  5. Yi HW, Kim SM, Kim SH, Shim JH, Choi MG, Lee JH, et al. Complications leading reoperation after gastrectomy in patients with gastric cancer: frequency, type, and potential causes. J Gastric Cancer 2013;13:242-246. https://doi.org/10.5230/jgc.2013.13.4.242
  6. Paroz A, Calmes JM, Giusti V, Suter M. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg 2006;16:1482-1487. https://doi.org/10.1381/096089206778870102
  7. Steele KE, Prokopowicz GP, Magnuson T, Lidor A, Schweitzer M. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc 2008;22:2056-2061. https://doi.org/10.1007/s00464-008-9749-7
  8. Larkin JO, Cooke F, Ravi N, Reynolds JV. Internal hernia following total gastrectomy with Roux-en-Y reconstruction. Ann R Coll Surg Engl 2011;93:e71-e73. https://doi.org/10.1308/147870811X590333
  9. Balazs A, Forgacs A, Flautner L, Kupcsulik P. A case of unusual complication of diaphragmatic herniation of transverse colon following transhiatal esophagectomy. Orv Hetil 1997;138:2535-2538.
  10. Aly A, Watson DI. Diaphragmatic hernia after minimally invasive esophagectomy. Dis Esophagus 2004;17:183-186. https://doi.org/10.1111/j.1442-2050.2004.00399.x
  11. Price TN, Allen MS, Nichols FC 3rd, Cassivi SD, Wigle DA, Shen KR, et al. Hiatal hernia after esophagectomy: analysis of 2,182 esophagectomies from a single institution. Ann Thorac Surg 2011;92:2041-2045. https://doi.org/10.1016/j.athoracsur.2011.08.013
  12. Tashiro Y, Murakami M, Otsuka K, Saito K, Saito A, Motegi K, et al. Intrathoracic hernia after total gastrectomy. Case Rep Gastroenterol 2016;10:1-6. https://doi.org/10.1159/000443268
  13. Hamaloglu E, Topaloglu S, Torer N. Diaphragmatic herniation after transhiatal esophagectomy. Dis Esophagus 2002;15:186-188. https://doi.org/10.1046/j.1442-2050.2002.00233.x
  14. van Sandick JW, Knegjens JL, van Lanschot JJ, Obertop H. Diaphragmatic herniation following oesophagectomy. Br J Surg 1999;86:109-112. https://doi.org/10.1046/j.1365-2168.1999.00979.x
  15. Choi YU, North JH Jr. Diaphragmatic hernia after Ivor-Lewis esophagectomy manifested as lower gastrointestinal bleeding. Am Surg 2001;67:30-32.
  16. Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 2006;7:644-651. https://doi.org/10.1016/S1470-2045(06)70766-5
  17. Bracale U, Marzano E, Nastro P, Barone M, Cuccurullo D, Cutini G, et al. Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 2010;24:2475-2479. https://doi.org/10.1007/s00464-010-0988-z
  18. Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol 2017;23:8553-8561. https://doi.org/10.3748/wjg.v23.i48.8553
  19. Santos Bdo N, de Oliveira MB, Peixoto RD. Hiatal hernia as a total gastrectomy complication. Case Rep Oncol 2016;9:100-105. https://doi.org/10.1159/000443633
  20. Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2006;16:1265-1271. https://doi.org/10.1381/096089206778663689
  21. Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 2005;19:34-39. https://doi.org/10.1007/s00464-003-8515-0
  22. Coleman MH, Awad ZT, Pomp A, Gagner M. Laparoscopic closure of the Petersen mesenteric defect. Obes Surg 2006;16:770-772. https://doi.org/10.1381/096089206777346727
  23. Bauman RW, Pirrello JR. Internal hernia at Petersen's space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure--a single surgeon series of 1047 cases. Surg Obes Relat Dis 2009;5:565-570. https://doi.org/10.1016/j.soard.2008.10.013
  24. Miyashiro LA, Fuller WD, Ali MR. Favorable internal hernia rate achieved using retrocolic, retrogastric alimentary limb in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2010;6:158-162. https://doi.org/10.1016/j.soard.2009.12.005

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