Prevention of Petersen's Hernia After Laparoscopic Gastrectomy

* Aim of this study To compare the cases underwent operation to treat intestinal obstruction caused by Peterson hernia within 3 years after laparoscopic gastrectomy between closure method and Mefix methods. * Primary end point: The cases underwent operation to treat intestinal obstruction caused by Peterson hernia within 3 years after laparoscopic gastrectomy was not- inferior between Closure and MEFIX. * Secondary endpoint: Procedures' times (minutes), bleeding, Hospital stays (days) Occurrence of postoperative small bowel obstruction within 30 days after surgery, Short-term complications within 30 days after surgery, Occurrence of Petersen's Hernia according to the use of anti-adhesion agents, anastomotic methods, CLOSURE or MEFIX previous surgical suture condition, hernia degree, and bowel condition (strangulation, perforation) at the timing of emergent operation for treatment of Petersen's Hernia obstructions

Sex

All

Minimum age

20 Years

Inclusion Criteria:

: histological proven primary gastric adenocarcinoma

* no evidence of other distant metastasis
* R0 resection
* laparoscopic or robotic gastrectomy
* and reconstructed by Roux-en-Y reconstruction or the Billroth II procedure
* patient with appropriate conditions of activity; 0 or 1 on Eastern Cooperative Oncology Group (ECOG) scale
* patient who have not previously received chemotherapy or radiation treatment in the abdomen.
* patinet who signed the consent form
* cTNM stage I or II or III

Exclusion Criteria:

* active double cancer (synchronous and metachronous double cancer within 5 disease-free years),

  * carcinoma in situ,
  * open gastrectomy,
  * reconstructed by Billroth I procedure,
  * gastric cancer recurrence, ;a history of gastrectomy. ;
  * a patient who has the history of abdominal surgery except laparoscopic appendectomy and gallbladder resection, and laparoscopic gynecologic surgery due to benign disease, and Cesarean section.
  * a patient who need co-ordination for other organs in preoperative examination (However, laparoscopic cholecystectomy is included in the selection criteria due to gallbladder polyps, and gallbladder disease).
  * Pregnant women, lactating women
  * a patient with mental illness (a person diagnosed with mental illness in medical records)
  * a patient who are taking corticosteroid whole-body (including herbal medicine)
  * a patient who has an uncontrolled history of angina or myocardial infarction within six months of the study;
  * uncontrolled hypertension
  * a patient who has a serious respiratory disease that requires continuous oxygen therapy;

• RESULTMin JS, Jeong SH, Park JH, Kim TH, Hong SC, Jung EJ, Ju YT, Jeong CY, Lee JK, Park M, Lee YJ. Prevention of Petersen's hernia using jejunal mesentery fixing (Mefix). Minim Invasive Ther Allied Technol. 2022 Apr;31(4):580-586. doi: 10.1080/13645706.2020.1848872. Epub 2020 Dec 3. PMID 33269633
• DERIVEDPark JK, Kim DH, Jeon TY, Jeong SH, Kim TH, Min JS, Kim RB, Lee YJ, Park JH, Son YG, Yoon KY, Seo KW, Kim KH, Kim Y, Chae HD, Hwang SH, Lee SH, Chung JH, Kim HI, Park DJ, Kim KH, Seo SH, Oh SJ, Lee WY, In Choi C. Comparison between the mesenteric fixation method (MEFIX) and conventional methods at preventing the occurrence of Petersen's hernia: a study protocol for a multicenter randomized controlled trial. Trials. 2024 Jan 2;25(1):7. doi: 10.1186/s13063-023-07841-9. PMID 38167216