Abstract

Backgroundand 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.MethodsData 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.ResultsIn 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).ConclusionsSRA 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.

Highlights

  • Several studies have documented better short-term outcomes of laparoscopic colectomy as compared to conventional open colectomy [1,2,3,4,5]

  • Postoperative intestinal obstruction is mainly caused by adhesions of the small intestine, but may rarely be caused by an internal hernia projecting through a post-colectomy mesenteric defect [8]

  • We investigated three cases of internal hernia passing through the defect around the preserved superior rectal artery (SRA) after laparoscopic leftsided colectomy

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Summary

Introduction

Several studies have documented better short-term outcomes of laparoscopic colectomy as compared to conventional open colectomy [1,2,3,4,5]. Several reports have shown that laparoscopic colectomy is associated with a lower incidence of small bowel obstruction than open colectomy. The reported rates of postoperative small bowel obstruction after laparoscopic colectomy and open colectomy are 2.0%–7.8% and 3.0%–18.3%, respectively [1,5,6,7]. Incomplete closure of the mesenteric defect may leave a narrow residual defect, which may increase the risk of internal hernia [11]. For these reasons, many surgeons leave the defect open during laparoscopic surgery [12]. We investigated three cases of internal hernia passing through the defect around the preserved SRA after laparoscopic leftsided colectomy.

Patient selection and treatment
Surgical technique
Measurement of the defect behind the SRA
Statistical analysis
Frequency of internal hernia
Postoperative evaluation of the defect behind the SRA
Case presentation
Discussion
Ethical approval
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