Internal Hernia after Laparoscopic Right Hemicolectomy with Intracorporeal Anastomosis—A Case Report—

Abstract

Intracorporeal anastomosis after laparoscopic colectomy has been introduced in recent years in Japan. We have also performed this procedure since 2020, but we have not fully shared the pitfalls of this procedure because it is a new method compared with extracorporeal anastomosis. The case of a 67-year-old man who developed an internal hernia on the 15^th postoperative day after laparoscopic right hemicolectomy for ascending colon cancer is presented. Preoperative computed tomography and intraoperative findings showed that the small intestine was incarcerated from the dorsal side to the ventral side through the mesenteric defect. Laparoscopic adhesiolysis was performed on the 5^th day after onset. After dissecting the adhesions and repositioning the small intestine, the mesenteric defect was closed with an omental patch. Closure of the mesenteric defect was then performed with non-absorbable suture thread as is our routine, because of which we have never had a case of internal hernia after laparoscopic colectomy. In some papers on laparoscopic gastrectomy that introduced intracorporeal anastomosis earlier, closure of Petersen's defect after Roux-en-Y reconstruction was recommended due to the risk of internal hernia. Our experience suggests that the mesenteric defect of reconstructed intestine needs to be closed after laparoscopic colectomy with intracorporeal anastomosis.