Surgical endoscopy · 2026
Closure of mesenteric defect reduces symptomatic internal hernia in minimally invasive surgery for splenic flexure colon cancer: a single‑center retrospective study in Japan.
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Kojima Tadahiro, Shiomi Akio, Manabe Shoichi, Tanaka Yusuke, Kasai Shunsuke, Igaki Takahiro, Mori Yukihiro
Аннотация
BACKGROUND: An internal hernia is a rare postoperative complication that can be fatal after minimally invasive surgery (MIS) for colorectal cancer. The risk factors for internal hernia and effective preventive strategies, including the role of mesenteric defect closure, remain unclear. We hypothesized that splenic flexure colon cancer (SFC) after MIS had a relatively high incidence of internal hernia due to the tumor location and the characteristics of the surgical procedure, and that prevention of internal hernia development is necessary. We evaluated the risk factors for symptomatic internal hernia and the efficacy of mesenteric defect closure after MIS for SFC.
METHODS: We conducted a retrospective cohort study of consecutive patients who underwent MIS for SFC between April 2010 and April 2024. Risk factors for symptomatic internal hernia were analyzed. Additionally, the incidence of symptomatic internal hernia and operative outcomes were compared between the open (Open) and closed (Closed) mesenteric defect groups using propensity score matching (PSM).
RESULTS: Among 172 eligible patients, six patients (3.5%) developed symptomatic internal hernia after MIS for SFC. On univariate analysis, only closure of the mesenteric defect was significantly associated with a lower incidence of internal hernia (odds ratio [OR], 0.073; 95% confidence interval [CI], 0.001-0.637; p = 0.013). After PSM (n = 116), the Closed group showed a significant association with a lower incidence of internal hernia compared with the Open group (OR, 0.083; CI 0.001-0.761; p = 0.024). No increase in postoperative complications was observed in the Closed group.
CONCLUSION: Closure of the mesenteric defect is associated with a reduced incidence of symptomatic internal hernia and can be performed safely after MIS for SFC. Considering the potential severity of internal hernia, routine closure of mesenteric defects is recommended whenever feasible, particularly in patients with significant comorbidities.
METHODS: We conducted a retrospective cohort study of consecutive patients who underwent MIS for SFC between April 2010 and April 2024. Risk factors for symptomatic internal hernia were analyzed. Additionally, the incidence of symptomatic internal hernia and operative outcomes were compared between the open (Open) and closed (Closed) mesenteric defect groups using propensity score matching (PSM).
RESULTS: Among 172 eligible patients, six patients (3.5%) developed symptomatic internal hernia after MIS for SFC. On univariate analysis, only closure of the mesenteric defect was significantly associated with a lower incidence of internal hernia (odds ratio [OR], 0.073; 95% confidence interval [CI], 0.001-0.637; p = 0.013). After PSM (n = 116), the Closed group showed a significant association with a lower incidence of internal hernia compared with the Open group (OR, 0.083; CI 0.001-0.761; p = 0.024). No increase in postoperative complications was observed in the Closed group.
CONCLUSION: Closure of the mesenteric defect is associated with a reduced incidence of symptomatic internal hernia and can be performed safely after MIS for SFC. Considering the potential severity of internal hernia, routine closure of mesenteric defects is recommended whenever feasible, particularly in patients with significant comorbidities.