TITLE

Internal Herniation Following Laparoscopic Left Hemicolectomy: An Underreported Event

AUTHOR(S)
Saklani, Avanish; Naguib, Nader; Tanner, Nicola; Moorhouse, Stephanie; Davies, Clare Elizabeth; Masoud, Ashraf G.
PUB. DATE
July 2012
SOURCE
Journal of Laparoendoscopic & Advanced Surgical Techniques;Jul/Aug2012, Vol. 22 Issue 6, p496
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Purpose: Laparoscopic colorectal surgery creates fewer adhesions compared with open colorectal resection. Small bowel obstruction after laparoscopic colorectal resection may be caused by internal herniation of the small bowel through a colomesenteric defect, probably related to a lack of adhesion formation. This is seen especially after left colonic resections. Methods: A literature review was conducted using the key words 'intestinal obstruction' and 'laparoscopic left colonic resection,' and 9 documented case reports of obstruction following laparoscopic left colorectal resection were identified. We present 2 additional cases and discuss the etiology, diagnosis, management, and possible options for avoiding this complication. Results: In total, 167 consecutive laparoscopic procedures were performed in our study, and 8 were left hemicolectomies. Four of these patients (50%) developed intestinal obstruction, with 2 requiring surgical intervention for internal hernia. For the remaining 159 colorectal procedures, there were only 2 admissions with intestinal obstruction, with 1 patient requiring surgery ( P=.006). Conclusions: Laparoscopic left hemicolectomy carries a significant risk of internal herniation. Performing a laparoscopic subtotal colectomy or fashioning the colocolonic anastomosis through the small bowel mesentery may minimize this risk.
ACCESSION #
76373030

 

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