A cross sectional study to investigate internal hernia post left-sided colectomy preserving superior rectal artery

Tetsuro Taira; Koji Murono; Hiroaki Nozawa; Daisuke Hojo; Kazushige Kawai; Keisuke Hata; Toshiaki Tanaka; Soichiro Ishihara

doi:10.1016/j.amsu.2019.10.026

A cross sectional study to investigate internal hernia post left-sided colectomy preserving superior rectal artery

Ann Med Surg (Lond). 2019 Nov 4:48:124-128. doi: 10.1016/j.amsu.2019.10.026. eCollection 2019 Dec.

Authors

Tetsuro Taira¹, Koji Murono¹, Hiroaki Nozawa¹, Daisuke Hojo¹, Kazushige Kawai¹, Keisuke Hata¹, Toshiaki Tanaka¹, Soichiro Ishihara¹

Affiliation

¹ Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Abstract

Background: and 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.

Methods: Data 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.

Results: In 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).

Conclusions: SRA 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.

Keywords: IMA, Inferior mesenteric artery; Internal hernia; Laparoscopic surgery; Left colectomy; SMA, Superior mesenteric artery; SRA, Superior rectal artery; Stoma; Superior rectal artery.