Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients
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and Other Interventional Techniques
Prevalence of internal hernia following laparoscopic colorectal surgery: single‑center report on 1300 patients Giuseppe Portale1 · Chiara Cipollari1 · Matteo Zuin1 · Ylenia Spolverato1 · Valentino Fiscon1 Received: 9 May 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Internal hernia (IH) is an infrequent complication following colorectal resection with minimally invasive technique. The real prevalence is difficult to define and there are only few large series reporting data on this complication, often focusing only on left-sided resections. Aim of the study was to evaluate the occurrence of IH following laparoscopic colorectal resection (LCR), reporting clinical presentation and treatment. Methods Data from 1297 patients undergoing elective LCR for cancer or benign disease in a 15-year period (June 2005– March 2020) were prospectively collected. A database query was performed to search for small bowel obstructions requiring reintervention. Results Five patients presented symptomatic IH (prevalence = 0.38%) and required reintervention. The preceding surgical procedure was left hemicolectomy for diverticular disease in all patients. The mesenteric defect had been originally closed in 4/5 patients. The median time interval between initial surgery and the occurrence of IH was 1 (range: 0.3–10) month. In all cases a small bowel loop was found herniating through the mesocolic defect. Small bowel resection was required in one patient only. The median hospital stay following reintervention was 7 (range: 4–17) days. Conclusions IH following LCR is a rare but severe complication, potentially leading to death, if not promptly diagnosed and treated. Awareness of this complication, early recognition, and proper diagnostic and therapeutic management is mandatory allowing laparoscopic approach and often avoiding small bowel resection. Keywords Laparoscopy · Colorectal surgery · Internal hernia · Small bowel obstruction · Morbidity · Mortality · Reoperation Small bowel obstruction (SBO) is one of the most frequent cause of morbidity following laparoscopic colorectal surgery, with a prevalence of 1–3% [1, 2]. Adhesions are responsible for over half of the cases of SBO. On the other side, internal hernia (IH)—frequently described as complication of laparoscopic procedures such as cholecystectomy, Roux-en-Y gastric by-pass and Nissen fundoplication—is an uncommon cause of SBO after laparoscopic colorectal resection (LCR) [3–5]. The acceptance of laparoscopic approach for colorectal surgery, benign at the beginning and malignant subsequently, explains a constantly growing number of these procedures. This has certainly brought awareness of surgeons on all types of possible complications, even * Giuseppe Portale [email protected] 1
those less frequently reported, associated with these procedures, including IH. Unfortunately, though there are only few reports from large series in the literature, several case re
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