Prevention of Petersen’s hernia using jejunal mesentery fixing (Mefix)

Abstract

Background

The aim of this study was to compare the 1 year incidence of Petersen’s hernia between individuals who were treated with the jejunal mesentery fixing (Mefix) method and those with the closure of Petersen’s space method.

Material and methods

We retrospectively collected clinical data of patients who underwent gastrectomy for gastric cancers with the closure of Petersen’s space defect (N = 49) and Mefix (N = 26). The Mefix method was performed by fixing the jejunal mesentery (jejunojejunostomy below 30 cm) to the transverse mesocolon using nonabsorbable barbed sutures.

Results

The procedure time for mesentery fixing (3.7 ± 1.1 mins) was significantly shorter than that for Petersen’s space closure (7.5 ± 1.5 mins) (p < .001) although the operation times were similar between the two groups. There was no incidence of Petersen’s hernias postoperatively in both groups. One case of reoperation was reported in the closure group due to small bowel obstruction by kinking of the jejunojejunostomy.

Conclusion

We found no occurrence of Petersen’s hernias postoperatively in either group. We also found that the Mefix method was faster and easier to perform than the closure method. The Mefix method is an excellent alternative method to prevent the occurrence of Petersen’s hernia after B-II or Roux-en-Y reconstruction.

Keywords:

• Petersen’s hernia
• hernia
• laparoscopy
• gastric neoplasm
• bariatric surgery

Acknowledgements

The authors would like to thank Mi Kyung Seo, RN for assisting with data collection.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The exemption from informed consent requirement was permitted by Gyeongsang National University Hospital in Changwon and at the Dongnam Institute of Radiological and Medical Sciences in Busan, Korea Institutional Review Board.

Declaration of interest

Dr. Jae-Seok Min, Sang-Ho Jeong, Ji-ho Park, Taehan Kim, Soon-Chan Hong, Eun-Jung Jung, Young-tae Ju, Chi-Young Jeong, Jin-Kwon Lee, Miyeong Park, and Young-Joon Lee have no conflicts of interest or financial ties to disclose.