Prevention of Petersen's Hernia After Laparoscopic Gastrectomy

Surgeons closed Petersen's space between the mesentery of the jejunal Roux limb and the mesentery of the transverse colon at the posterior side of esophago-jejunostomy or gastro-jejunostomy from the mesentery root to the bowel side using a nonabsorbable barbed suture V-LocTM 3-0 (Medtronic VR, Minneapolis, MN, USA).

Surgeons fixed the jejunal mesentery (jejunojejunostomy\[J-J\] distal 30 cm) to the transverse mesocolon using non-absorbable barbed suture VLocTM 3-0 sutures. The suture area was exposed by grasping the jejunum side mesentery (jejunal side, at site 30cm distal J-J) and the transverse mesocolon (colonic side). The jejunal side mesentery was fixed to the colonic side mesocolon between the jejunum and the transverse colon using nonabsorbable barbed V-LocTM 3-0 sutures.The suture started between jejunal mesentery just below of SMA vascular arcade and transverse mesocolon, and it finished when it reaches the root of the mesentery. To anchor the mesentery, continuous suturing with V-Loc two-point backward sutures were performed at the final step.