Incidence of Internal and Petersen's Hernias Following Gastrectomy for Gastric Cancer: A Meta-Analysis of Surgical Approach and Preventive Closure

Abstract

Background Gastric cancer continues to pose a significant global health burden, with gastrectomy being the primary curative treatment. However, the increased performing of laparoscopic gastrectomy (LG) has been associated with a rising incidence of postoperative internal hernia (IH), particularly Petersen's hernia (pH), which may lead to bowel strangulation and necrosis. This meta-analysis aimed to compare the incidence of IH following LG versus open gastrectomy (OG) and to evaluate the preventive effect of Petersen's space closure on pH occurrence.Methods A systematic review and meta-analysis were conducted using PubMed and Embase to identify studies published in the past 25 years that reported IH or pH after gastrectomy for gastric cancer. Eligible studies compared (1) the incidence of IH between LG and OG or (2) the incidence of pH between closure and nonclosure of Petersen's space. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.Results Five studies comparing LG and OG demonstrated a significantly higher risk of IH in the LG group (OR 2.81, 95% CI: 1.40-5.62). A subgroup analysis limited to total gastrectomy showed a nonsignificant trend toward increased IH risk after LG (OR 6.12). Additionally, five studies showed that closure of Petersen's space significantly reduced the risk of pH (OR 5.73, 95% CI: 1.59-20.67).Conclusion Laparoscopic gastrectomy is associated with an increased risk of internal hernia compared to open surgery for gastric cancer. The preventive closure of Petersen's space should be considered mandatory, particularly during Roux-en-Y reconstruction after gastrectomy.