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

Figures & data

Figure 1. Steps of the Mefix procedure. (A) Schematic diagram of Petersen’s space (purple dotted line), jejunal mesentery (blue area, jejunal side, at site 30 cm distal J-J) with transverse mesocolon (red area, colonic side). (B) Exposure of the suture area jejunal side & colonic side (red line, SMA vascular arcade) (Step 1). (C) Step 2. The suture started between jejunal side just below of SMA vascular arcade and colonic side. (D,E) Step 3. To anchor the mesentery, two-point backward sutures were performed, and Mefix was done.

Table 1. Patient demographics.

Factors	Value
Age (years)	60.9 ± 11.9
Sex
Male	57 (76.0%)
Female	18 (24.0%)
BMI	22.2 ± 3.0
Tumor size (cm)	3.1 ± 1.6
TNM stage (AJCC TNM stage 7th edition)
I	58 (77.3%)
II	14 (18.7%)
III	3 (4%)
Operation time (minutes)	254.1 ± 63.0
Hospital stay (days)	14.2 ± 10.1
Approach methods
Laparoscopy	54 (72%)
Robot-assisted	21 (28%)
Operation type
Subtotal gastrectomy	66 (88%)
Total gastrectomy	5 (6.7%)
Proximal gastrectomy	4 (5.3%)
Anastomosis type
Billroth II	30 (40%)
RNY GJ	28 (37.3%)
uncut RNY GJ	9 (12%)
RNY EJ	4 (5.3%)
Double tract	4 (5.3%)
Petersen’s space repair
Closure	49 (65.3%)
Mesentery fixing	26 (34.9%)
Postoperative intestinal obstruction	1/75 (1.3%)
Follow up period (months)	25.4 ± 7.6

BMI: Body mass index; RNY: Roux-en Y; GJ: gastrojejunostomy; EJ: esophagojejunostomy; ASCPC: accordion severity classification of postoperative complications.

Table 2. Clinicopathologic comparison between Petersen closure group (closure) and distal mesentery fixing group (Mefix).

Factors	Closure group (N = 49)	Mefix group (N = 26)	p Value
Age (years)	61.1 ± 12.2	60.5 ± 11.4	.41
Sex
Male	32	25	.003
Female	17	1
BMI	21.9 ± 3.2	22.8 ± 2.6	.27
TNM stage*
I	37	21	.28
II	11	3
III	1	2
Approach methods
Laparoscopy	37	17	.32
Robot-assisted	12	9
Operation type
Subtotal gastrectomy	46	20	.01
Total gastrectomy	3	2
Proximal gastrectomy	0	4
Op time (minutes)	244.9 ± 55.3	244.5 ± 52.2	.85
Closure or jejunal mesentery fixing time (minutes)	7.5 ± 1.5	3.7 ± 1.1	<.001
Hospital stay (days)	11.8 ± 7.6	8.8 ± 3.6	.06
Follow up period (months)	27.9 ± 7.9	20.7 ± 4.0	<.01
Postoperative Petersen’s hernia incidence	0	0	NS
Postoperative small bowel obstruction	1	0	1.0

*AJCC TNM stage 7th edition, BMI: Body mass index; RNY: Roux-en Y; GJ: gastrojejunostomy; EJ: esophagojejunostomy; ASCPC: accordion severity classification of postoperative complications; NS: not-significant.