Internal Herniation Following Laparoscopic Left Hemicolectomy: An Underreported Event
- 1 June 2012
- journal article
- case report
- Published by Mary Ann Liebert Inc in Journal of Laparoendoscopic & Advanced Surgical Techniques
- Vol. 22 (5), 496-500
- https://doi.org/10.1089/lap.2011.0413
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.Keywords
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