Caractéristiques des hernies diaphragmatiques après œsophagectomie pour cancer

Hiatal hernia after esophagectomy - a report of two cases

Postoperative hiatal hernia after esophagectomy occurs with a frequency of 0.4-6%, and the local conditions following esophagectomy promote its occurrence. In the material presented here, hiatal hernia in the form of displacement of the colon to the mediastinum was established in 0.78% (2/256) of all performed esophagectomies. Both cases were reoperated successfully.

The incidence of hiatal hernia after minimally invasive esophagectomy

INTRODUCTION

Minimally invasive esophagectomy (MIE) has evolved as a means to minimize the morbidity of an operation which is traditionally associated with a significant risk. However, this approach may have its own unique postoperative complications. In this study, we describe the incidence and outcomes of hiatal hernia in a cohort of MIE patients.

METHODS

Clinical follow-up data on 114 patients who had undergone minimally invasive esophagectomy between 2003 and 2011 were retrospectively reviewed. Clinical presentation and computed tomography (CT) scans of the chest and abdomen were used to establish the diagnosis of hiatal herniation after minimally invasive esophagectomy. Age, gender, presenting complaint, comorbid conditions, clinical tumor stage, surgical specimen size, length and cost of hospital admissions, operation performed for hiatal herniation, and mortality were all recorded for analysis.

RESULTS

Nine (8%) of the 114 patients who underwent MIE had postoperative hiatal herniation. Five of these patients were asymptomatic. All patients except two who presented emergently were repaired laparoscopically on an elective basis. The average length of stay after hiatal hernia repair was 5.5 days (range 2-12) at an average charge of $40,785 (range $25,264-$83,953). At follow-up, one patient complained of symptoms associated with reflux.

CONCLUSION

Hiatal herniation is not a rare event after MIE. It is also associated with significant health-care cost and may be lethal. Most occurrences appear to be asymptomatic and, if detected, can be repaired with good resolution of symptoms, minimal associated morbidity, and no mortality.

[Complications following oesophagectomy: mechanism, detection, treatment and prevention]

Oesophageal surgery remains a relatively morbid operation with potentially devastating complications that can be minimized by prevention, early recognition, and appropriate management. Anastomotic leak, conduit necrosis, and pulmonary failure are the most serious complications. The management of complications following oesophagectomy is reviewed in the following section.