High prevalence of asymptomatic internal hernias after laparoscopic anterior resection in a retrospective analysis of postoperative computed tomography

• Published in: International journal of colorectal disease Vol. 35; no. 5; pp. 929 - 932
• Main Authors: Däster, Silvio, Xiang, Hao, Yang, Jessica, Rowe, David, Keshava, Anil, Rickard, Matthew J F X
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Cancer; Colon; Colon cancer; Colorectal cancer; Computed tomography; CT imaging; Female; Gastroenterology; Hepatology; Hernia; Humans; Internal Hernia - diagnostic imaging; Internal Hernia - epidemiology; Internal Hernia - etiology; Internal Medicine; Ischemia; Laparoscopic surgery; Laparoscopy; Laparoscopy - adverse effects; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology, Experimental; Prevalence; Proctology; Rectum; Retrospective Studies; Short Communication; Small intestine; Surgery; Tomography; Tomography, X-Ray Computed; Laparoscopic colorectal surgery; Laparoscopic anterior resection; Internal hernia; Mesenteric defects
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-020-03537-7

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.