Sereno Trabaldo Stefano, Anvari Mehran, Leroy Joel, Marescaux Jacques
Servicio de Cirugía Bariátrica y Metabólica, Real San José Hospital, Tarascos 3514-6, Fracc. Monraz, CP 44670, Guadalajara, Jalisco, México.
J Gastrointest Surg. 2009 Jun;13(6):1107-10. doi: 10.1007/s11605-009-0851-5. Epub 2009 Mar 17.
Laparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection.
During a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention.
A total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h.
Internal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific.
All mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed.
腹腔镜结直肠切除术正越来越受欢迎。经肠系膜缺损的内疝（SBH）已被描述，虽然罕见，但却是一种严重并发症。本研究的目的是评估腹腔镜结直肠切除术后内疝的发生率和结局。
在5年期间，所有接受腹腔镜左半结肠切除术的患者均纳入本研究。进行回顾性数据库查询，以查找所有需要手术再次干预的内疝患者。
2000年1月至2006年7月共进行了436例腹腔镜左半结肠切除术。5例男性患者出现有症状的内疝并需要再次手术。4例因癌症行切除术，1例因乙状结肠炎行切除术。3例最初未关闭肠系膜缺损。所有病例中，我们均发现经结肠系膜缺损的小肠疝。1例患者术后第2天因肠系膜缺血再次手术，24小时后死亡。
内疝是腹腔镜结肠切除术后一种罕见但致命的并发症。怀疑此诊断需要紧急再次手术，因为症状不具特异性。
结直肠腹腔镜手术中形成的所有肠系膜缺损均应仔细关闭。
