1
|
Kashyap SS, Abbas KA, Herron R, Abbas FA, Chudnovets A, Abbas G. Use of a mobilized, perfused, falciform ligament patch for repair of paraconduit herniation after robotic-assisted Ivor Lewis esophagectomy. JTCVS Tech 2024; 25:204-207. [PMID: 38899100 PMCID: PMC11184521 DOI: 10.1016/j.xjtc.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Sandeep S. Kashyap
- Department of Thoracic Surgery, CAMC Institute of Academic Medicine, Charleston, WVa
| | - Kamil A. Abbas
- West Virginia University School of Medicine, Morgantown, WVa
| | - Robert Herron
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | | | - Anna Chudnovets
- Department of Thoracic Surgery, CAMC Institute of Academic Medicine, Charleston, WVa
| | - Ghulam Abbas
- Department of Thoracic Surgery, CAMC Institute of Academic Medicine, Charleston, WVa
| |
Collapse
|
2
|
Barron JO, Ramji S, Nemoyer R, Tappuni S, Toth AJ, Tasnim S, Sudarshan M, Murthy SC, Blackstone EH, Raja S. Paraconduit hernia following esophagectomy: Is it safe to watch and wait? J Thorac Cardiovasc Surg 2024; 167:1628-1637.e2. [PMID: 37673124 DOI: 10.1016/j.jtcvs.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES We hypothesized that emergency complications related to asymptomatic paraconduit hernias may occur less often than generally believed. Therefore, we assessed the occurrence and timing of paraconduit hernia diagnosis after esophagectomy, as well as outcomes of these asymptomatic patients managed with a watch-and-wait approach. METHODS From 2006 to 2021, 1214 patients underwent esophagectomy with reconstruction at the Cleveland Clinic. Among these patients, computed tomography scans were reviewed to identify paraconduit hernias. Medical records were reviewed for timing of hernia diagnosis, hernia characteristics, and patient symptoms, complications, and management. During this period, patients with asymptomatic paraconduit hernias were typically managed nonoperatively. RESULTS Paraconduit hernias were identified in 37 patients. Of these, 31 (84%) had a pre-esophagectomy hiatal hernia. Twenty-one hernias (57%) contained colon, 7 hernias (19%) contained pancreas, and 9 hernias (24%) contained multiple organs. Estimated prevalence of paraconduit hernia was 3.3% at 3 years and 7.7% at 10 years. Seven patients (19%) had symptoms, 4 of whom were repaired electively, with 2 currently awaiting repairs. No patient with a paraconduit hernia experienced an acute complication that required emergency intervention. CONCLUSIONS The risk of paraconduit hernia increases with time, suggesting that long-term symptom surveillance is reasonable. Emergency complications as a result of asymptomatic paraconduit hernias are rare. A small number of patients will experience hernia-related symptoms, sometimes years after hernia diagnosis. Our findings suggest that observation of asymptomatic paraconduit hernias (watch and wait) may be considered, with repair considered electively in patients with persistent symptoms.
Collapse
Affiliation(s)
- John O Barron
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sadhvika Ramji
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rachel Nemoyer
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shahed Tappuni
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Andrew J Toth
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sadia Tasnim
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Monisha Sudarshan
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| |
Collapse
|
3
|
Lagisetty K. Commentary: Watch and wait for disaster? Is it safe to watch and wait paraconduit hernias following esophagectomy? J Thorac Cardiovasc Surg 2024; 167:1641-1642. [PMID: 37863181 DOI: 10.1016/j.jtcvs.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Kiran Lagisetty
- Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
| |
Collapse
|
4
|
Chang SH, Molena D. Paraconduit hernias after minimally invasive esophagectomy. JTCVS Tech 2024; 24:213-216. [PMID: 38835574 PMCID: PMC11145420 DOI: 10.1016/j.xjtc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Stephanie H. Chang
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY
| | - Daniela Molena
- Thoracic Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
5
|
Brunner S, Müller DT, Eckhoff JA, Lange V, Chon SH, Schmidt T, Schröder W, Bruns CJ, Fuchs HF. Postesophagectomy Diaphragmatic Prolapse after Robot-Assisted Minimally Invasive Esophagectomy (RAMIE). J Clin Med 2023; 12:6046. [PMID: 37762986 PMCID: PMC10531742 DOI: 10.3390/jcm12186046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Postesophagectomy diaphragmatic prolapse (PDP) is a major complication after esophagectomy with significant mortality and morbidity. However, in the current literature, treatment and outcomes are not evaluated for patients undergoing an Ivor Lewis Robot-assisted minimally invasive esophagectomy (IL-RAMIE). The aim of this study is to evaluate the incidence of PDP after IL-RAMIE. Moreover, the study aims to determine whether using a minimally invasive approach in the management of PDP after an IL-RAMIE procedure is safe and feasible. MATERIALS AND METHODS This study includes all patients who received an IL-RAMIE at our high-volume center (>200 esophagectomies/year) between April 2017 and December 2022 and developed PDP. The analysis focuses on time to prolapse, symptoms, treatment, surgical method, and recurrence rates of these patients. RESULTS A total of 185 patients underwent an IL-RAMIE at our hospital. Eleven patients (5.9%) developed PDP. Patients presented with PDP after a medium time of 241 days with symptoms like reflux, nausea, vomiting, and pain. One-third of these patients did not suffer from any symptoms. In all cases, a CT scan was performed in which the colon transversum always presented as the herniated organ. In one patient, prolapse of the small intestine, pancreas, and greater omentum also occurred. A total of 91% of these patients received a revisional surgery in a minimally invasive manner with a mean hospital stay of 12 days. In four patients, PDP recurred (36%) after 13, 114, 119 and 237 days, respectively. CONCLUSION This study shows that a minimally invasive approach in repositioning PDP is a safe and effective option after IL-RAMIE.
Collapse
Affiliation(s)
- Stefanie Brunner
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Dolores T. Müller
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Jennifer A. Eckhoff
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Valentin Lange
- Faculty of Medicine, University of Cologne, 50923 Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Christiane J. Bruns
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| | - Hans F. Fuchs
- Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany
| |
Collapse
|
6
|
Kuvendjiska J, Jasinski R, Hipp J, Fink M, Fichtner-Feigl S, Diener MK, Hoeppner J. Postoperative Hiatal Hernia after Ivor Lewis Esophagectomy-A Growing Problem in the Age of Minimally Invasive Surgery. J Clin Med 2023; 12:5724. [PMID: 37685791 PMCID: PMC10488699 DOI: 10.3390/jcm12175724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Even though minimally invasive esophagectomy is a safe and oncologically effective procedure, several authors have reported an increased risk of postoperative hiatal hernia (PHH). This study evaluates the incidence and risk factors of PHH after hybrid minimally invasive (HMIE) versus open esophagectomy (OE). METHODS A retrospective single-center analysis was performed on patients who underwent Ivor Lewis esophagectomy between January 2009 and April 2018. Computed tomography scans and patient files were reviewed to identify the PHH. RESULTS 306 patients were included (152 HMIE; 154 OE). Of these, 23 patients (8%) developed PHH. Most patients (13/23, 57%) were asymptomatic at the time of diagnosis and only 4 patients (17%) presented in an emergency setting with incarceration. The rate of PHH was significantly higher after HMIE compared to OE (13.8% vs. 1.3%, p < 0.001). No other risk factors for the development of PHH were identified in uni- or multi-variate analysis. Surgical repair of PHH was performed in 19/23 patients (83%). The recurrence rate of PHH after surgical repair was 32% (6/19 patients). CONCLUSIONS The development of PHH is a relevant complication after hybrid minimally invasive esophagectomy. Although most patients are asymptomatic, surgical repair is recommended to avoid incarceration with potentially fatal outcomes. Innovative techniques for the prevention and repair of PHH are urgently needed.
Collapse
Affiliation(s)
- Jasmina Kuvendjiska
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Robert Jasinski
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Julian Hipp
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Mira Fink
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Markus K. Diener
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
| | - Jens Hoeppner
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
- Department of Surgery, University Medical Center Schleswig-Holstein, 23538 Lübeck, Germany
| |
Collapse
|
7
|
Lee AHH, Oo J, Cabalag CS, Link E, Duong CP. Increased risk of diaphragmatic herniation following esophagectomy with a minimally invasive abdominal approach. Dis Esophagus 2022; 35:6373570. [PMID: 34549284 DOI: 10.1093/dote/doab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Diaphragmatic herniation is a rare complication following esophagectomy, associated with risks of aspiration pneumonia, bowel obstruction, and strangulation. Repair can be challenging due to the presence of the gastric conduit. We performed this systematic review and meta-analysis to determine the incidence and risk factors associated with diaphragmatic herniation following esophagectomy, the timing and mode of presentation, and outcomes of repair. METHODS A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed using four major databases. A meta-analysis of diaphragmatic herniation incidence following esophagectomies with a minimally invasive abdominal (MIA) approach compared with open esophagectomies was conducted. Qualitative analysis was performed for tumor location, associated symptoms, time to presentation, and outcomes of postdiaphragmatic herniation repair. RESULTS This systematic review consisted of 17,052 patients from 32 studies. The risk of diaphragmatic herniation was 2.74 times higher in MIA esophagectomy compared with open esophagectomy, with pooled incidence of 6.0% versus 3.2%, respectively. Diaphragmatic herniation was more commonly seen following surgery for distal esophageal tumors. Majority of patients (64%) were symptomatic at diagnosis. Presentation within 30 days of operation occurred in 21% of cases and is twice as likely to require emergent repair with increased surgical morbidity. Early diaphragmatic herniation recurrence and cardiorespiratory complications are common sequelae following hernia repair. CONCLUSIONS In the era of MIA esophagectomy, one has to be cognizant of the increased risk of diaphragmatic herniation and its sequelae. Failure to recognize early diaphragmatic herniation can result in catastrophic consequences. Increased vigilance and decreased threshold for imaging during this period is warranted.
Collapse
Affiliation(s)
- Adele Hwee Hong Lee
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - June Oo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carlos S Cabalag
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Emma Link
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Cuong Phu Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
8
|
Paraconduit hiatal hernia following minimally invasive oesophagectomy in an emergent setting. Indian J Thorac Cardiovasc Surg 2022; 38:445-447. [DOI: 10.1007/s12055-022-01359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022] Open
|
9
|
Hölscher AH, Fetzner UK. Paraconduit hiatal hernia after esophagectomy. Prevention-indication for surgery-surgical technique. Dis Esophagus 2021; 34:6257762. [PMID: 33912913 DOI: 10.1093/dote/doab025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 12/11/2022]
Affiliation(s)
- A H Hölscher
- Contilia Center for Esophageal Diseases, Elisabeth-Hospital Essen, Cooperation Partner of West German Tumor Center, University Medicine Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - U K Fetzner
- Department for General-, Visceral-, Thoracic-, Pediatric- and Endocrine Surgery, Johannes Wesling Hospital, University Clinic Ruhr University Bochum, Hans-Nolte-Str. 1, 32429 Minden, Germany
| |
Collapse
|
10
|
Thammineedi SR, Raju KVVN, Patnaik SC, Saksena AR, Iyer RR, Sudhir R, Rayani BK, Smith LM, Are C, Nusrath S. Laparoscopic Repair of Acute Post-Esophagectomy Diaphragmatic Herniation Following Minimal Access Esophagectomy. Indian J Surg Oncol 2021; 12:729-736. [DOI: 10.1007/s13193-021-01415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022] Open
|
11
|
Chung SK, Bludevich B, Cherng N, Zhang T, Crawford A, Maxfield MW, Whalen G, Uy K, Perugini RA. Paraconduit Hiatal Hernia Following Esophagectomy: Incidence, Risk Factors, Outcomes and Repair. J Surg Res 2021; 268:276-283. [PMID: 34392181 DOI: 10.1016/j.jss.2021.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paraconduit hiatal hernia (PCHH) is a known complication of esophagectomy with significant morbidity. PCHH may be more common with the transition to a minimally invasive approach and improved survival. We studied the PCHH occurrence following minimally invasive esophagectomy to determine the incidence, treatment, and associated risk factors. METHODS We retrospectively reviewed records of patients who underwent esophagectomy at an academic tertiary care center between 2013-2020. We divided the cohort into those who did and did not develop PCHH, identifying differences in demographics, perioperative characteristics and outcomes. We present video of our laparoscopic repair with mesh. RESULTS Of 49 patients who underwent esophagectomy, seven (14%) developed PCHH at a median of 186 d (60-350 d) postoperatively. They were younger (57 versus 64 y, P< 0.01), and in cases of resection for cancer, more likely to develop tumor recurrence (71% versus 23%, P= 0.02). There was a significant difference in 2-y cancer free survival of patients with a PCHH (PCHH 19% versus no hernia 73%, P< 0.01), but no significant difference in 5-y overall survival (PCHH 36% versus no hernia 68%, P= 0.18). Five of seven PCHH were symptomatic and addressed surgically. Four PCHH repairs recurred at a median of 409 d. CONCLUSIONS PCHH is associated with younger age and tumor recurrence, but not mortality. Safe repair of PCHH can be performed laparoscopically with or without mesh. Further studies, including systematic video review, are needed to address modifiable risk factors and identify optimal techniques for durable repair of post-esophagectomy PCHH.
Collapse
Affiliation(s)
- Sebastian K Chung
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA.
| | - Bryce Bludevich
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Nicole Cherng
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Tracy Zhang
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Allison Crawford
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Mark W Maxfield
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Giles Whalen
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Karl Uy
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Richard A Perugini
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
12
|
Bona D, Lombardo F, Matsushima K, Cavalli M, Panizzo V, Mendogni P, Bonitta G, Campanelli G, Aiolfi A. Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis. Langenbecks Arch Surg 2021; 406:1819-1829. [PMID: 34129106 PMCID: PMC8481172 DOI: 10.1007/s00423-021-02214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
Introduction The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer. Materials and methods Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted. Results Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0–22.0%), 1.4% (95% CI = 0.8–2.2%), 35% (95% CI = 20.0–54.0%), and 5.0% (95% CI = 3.0–8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0–21.6%). Conclusions Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.
Collapse
Affiliation(s)
- Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Francesca Lombardo
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA
| | - Marta Cavalli
- Department of Surgery, University of Insubria, Milan, Italy
| | - Valerio Panizzo
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | | | - Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| |
Collapse
|
13
|
Paraconduit Hernia in the Era of Minimally Invasive Esophagectomy: Underdiagnosed? Ann Thorac Surg 2021; 111:1812-1819. [DOI: 10.1016/j.athoracsur.2020.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/05/2020] [Accepted: 07/28/2020] [Indexed: 02/05/2023]
|
14
|
Asti E, Lovece A, Bernardi D, Milito P, Manzo CA, Bonavina L. Falciform Ligament Flap as Crural Buttress in Laparoscopic Hiatal Hernia Repair. J Laparoendosc Adv Surg Tech A 2021; 31:738-742. [PMID: 33970030 DOI: 10.1089/lap.2021.0244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Crural repair is an essential technical component in laparoscopic hiatal hernia surgery, but there is no consensus regarding the optimal method to prevent postoperative hernia recurrence. Mesh augmentation, especially with permanent materials, is associated with dysphagia and complications. The rotational falciform ligament flap (FLF) has been reported to be effective in reinforcing standard suture closure of the hiatus. Materials and Methods: Patients with primary or secondary hiatal hernia in whom FLF was used to buttress the hiatus repair were included. The FLF was dissected from the anterior abdominal wall, detached from the umbilical area, and transposed below the left lateral liver segment to buttress the cruroplasty. Indocyanine green fluorescence was used to assess vascularization of the flap before and after mobilization. Results: Eighteen consecutive patients underwent laparoscopic FLF cruroplasty reinforcement between October 2019 and January 2021. Indications were primary hiatal hernia (n = 9), recurrent hiatal hernia (n = 4), postsleeve gastrectomy hernia (n = 1), prophylactic hiatal repair during esophagectomy and gastric conduit reconstruction (n = 2), and postesophagectomy hernia (n = 2). All flaps were well vascularized and covered the entire hiatal area. There was no morbidity. At a median follow-up of 8 months (range 3-15), the symptomatic and quality of life scores significantly improved compared with baseline (P < .001), and no anatomic hernia recurrences were detected. Conclusions: FLF is safe for crural buttress and is a viable alternative to mesh in laparoscopic hiatal hernia surgery.
Collapse
Affiliation(s)
- Emanuele Asti
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Andrea Lovece
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Daniele Bernardi
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Pamela Milito
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Carlo Alberto Manzo
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| |
Collapse
|
15
|
Technique for Imbricated Repair of Paraconduit Conduit Hernia. Ann Thorac Surg 2021; 112:e459-e461. [PMID: 33794160 DOI: 10.1016/j.athoracsur.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022]
Abstract
Minimally invasive esophagectomy (MIE) is associated with an increased rate of paraconduit hernia. Recurrences after repair are typically adjacent to the gastroepiploic vessel passage through the hiatus. This technique provides a novel solution and approach to prevent recurrence or re-recurrence after repair by imbricating the blood supply to the conduit within the conduit, allowing circumferential fixation while protecting the conduit blood supply.
Collapse
|
16
|
Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency. Hernia 2021; 26:259-278. [PMID: 33713205 PMCID: PMC8881432 DOI: 10.1007/s10029-021-02380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/14/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. METHODS Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. RESULTS Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. CONCLUSION Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.
Collapse
|
17
|
Puccetti F, Cossu A, Parise P, Barbieri L, Elmore U, Carresi A, De Pascale S, Fumagalli Romario U, Rosati R. Diaphragmatic hernia after Ivor Lewis esophagectomy for cancer: a retrospective analysis of risk factors and post-repair outcomes. J Thorac Dis 2021; 13:160-168. [PMID: 33569196 PMCID: PMC7867823 DOI: 10.21037/jtd-20-1974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with incidence and risk factors not clearly demonstrated. This study evaluates presenting characteristics and repair outcomes in PEDH after Ivor Lewis esophagectomy for cancer. Methods All consecutive patients who underwent esophageal cancer surgery between March 1997 and April 2018 at two high-volume centers were included. The patients underwent Ivor Lewis esophagectomy and were managed according to a standardized follow-up care plan. The primary outcomes included PEDH incidence, risk factor identification, and surgical results after hernia repair. Patient characteristics and perioperative data were collected and a multivariate analysis was performed to identify risk factors for PEDH. Results A total of 414 patients were enrolled and 22 (5.3%) were diagnosed with PEDH during a median follow-up period of 16 (range, 6–177) months. All patients underwent surgical repair and 16 (73%) required treatment within 24 hours. PEDH repair was mainly performed through a laparoscopic approach (77.3%), with an overall postoperative morbidity of 22.7% and one mortality case. The median length of hospital stay was 6 (range, 2–95) days, and no early recurrences were observed, although three (13.6%) cases relapsed over a median follow-up of 10.1 months after hernia repair. Univariate analysis demonstrated a statistically significant association between PEDH and neoadjuvant chemoradiotherapy (P=0.016), pathological complete response (P=0.001), and lymph node harvest (P=0.024). On the other hand, multivariate analysis identified pathological complete response [3.616 (1.384–9.449), P=0.009] and lymph node harvest [3.029 (1.140–8.049), P=0.026] as the independent risk factors for developing PEDH. Conclusions PEDH represents a relevant surgical complication after Ivor Lewis esophagectomy for cancer, including a 5.3% incidence and requiring surgical repair. Pathological complete response and lymph node harvest were found to be independent risk factors for PEDH, independently of the esophagectomy technique.
Collapse
Affiliation(s)
- Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Agnese Carresi
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Stefano De Pascale
- Digestive Surgery Unit, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| |
Collapse
|
18
|
Fuchs HF, Knepper L, Müller DT, Bartella I, Bruns CJ, Leers JM, Schröder W. Transdiaphragmatic herniation after transthoracic esophagectomy: an underestimated problem. Dis Esophagus 2020; 33:5841798. [PMID: 32440678 DOI: 10.1093/dote/doaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
Diaphragmatic transposition of intestinal organs is a major complication after esophagectomy and can be associated with significant morbidity and mortality. This study aims of to analyze a large series of patients with this condition in a single high-volume center for esophageal surgery and to suggest a novel treatment algorithm. Patients who received surgery for postesophagectomy diaphragmatic herniation between October 2003 and December 2017 were included. Retrospective analysis of demographic, clinical and surgical data was performed. Outcomes of measure were initial clinical presentation, postoperative complications, in-hospital mortality and herniation recurrence. A total of 39 patients who had surgery for postesophagectomy diaphragmatic herniation were identified. Diaphragmatic herniation occurred after a median time of 259 days following esophagectomy with the highest prevalence between 1 and 12 months. A total of 84.6% of the patients had neoadjuvant radiochemotherapy prior to esophagectomy. The predominantly effected organ was the transverse colon (87.2%) prolapsing into the left hemithorax (81.6%). A total of 20 patients required emergency surgery. Surgery always consisted of reposition of the intestinal organs and closure of the hiatal orifice; a laparoscopic approach was used in 25.6%. Major complications (Dindo-Clavien ≥ IIIb) were observed in 35.9%, hospital mortality rate was 7.7%. Three patients developed recurrent diaphragmatic herniation during follow-up. Postesophagectomy diaphragmatic herniation is a functional complication of the late postoperative course and predominantly occurs in patients with locally advanced adenocarcinoma having chemoradiation before Ivor-Lewis esophagectomy. Due to a high rate of emergency surgery with life-threatening complications not a 'wait-and-see' strategy but early surgical repair may be indicated.
Collapse
Affiliation(s)
- Hans F Fuchs
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| | - Laura Knepper
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| | - Dolores T Müller
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| | - Isabel Bartella
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| | - Jessica M Leers
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| | - Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplantation surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
19
|
Gust L, Nafteux P, Allemann P, Tuech JJ, El Nakadi I, Collet D, Goere D, Fabre JM, Meunier B, Dumont F, Poncet G, Passot G, Carrere N, Mathonnet M, Lebreton G, Theraux J, Marchal F, Barabino G, Thomas PA, Piessen G, D'Journo XB. Hiatal hernia after oesophagectomy: a large European survey. Eur J Cardiothorac Surg 2020; 55:1104-1112. [PMID: 30596989 DOI: 10.1093/ejcts/ezy451] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Hiatal hernias (HH) after oesophagectomy are rare, and their surgical management is not well standardized. Our goal was to report on the management of HH after oesophagectomy in high-volume tertiary European French-speaking centres. METHODS We conducted a retrospective multicentre study among 19 European French-speaking departments of upper gastrointestinal and/or thoracic surgery. All patients scheduled or operated on for the repair of an HH after oesophagectomy were collected between 2000 and 2016. Demographics, details of the initial procedure, surgical management and long-term outcome were analysed. RESULTS Seventy-nine of 6608 (1.2%) patients who had oesophagectomies were included in the study. The postoesophagectomy diagnostic interval of an HH after oesophagectomy was ≤90 days (n = 17; 21%), 13 were emergency cases; between 91 days and 1 year, n = 21 (27%), 13 in emergency; ≥1 year, n = 41 (52%), 17 in emergency. The time to occurrence of HH after oesophagectomy was shorter after laparoscopy (median 308 days; interquartile range 150-693) compared to that after laparotomy (median 562 days, interquartile range 138-1768; P = 0.01). The incidence of HH after oesophagectomy was 0.73% (22/3010) after open surgery and 1.4% (26/1761) after laparoscopy (P = 0.03). Among the 79 patients, 78 were operated on: 35 had laparotomies (45%), 19 had laparoscopies (24%) and 24 (31%) had transthoracic approaches. Among the 43 urgent surgeries, 35 were open (25 laparotomies and 10 transthoracic approaches) and 8 were laparoscopies (conversion rate, 25%). Nine patients required bowel resections. Morbidity occurred in 36 (46%) patients with 1 postoperative death (1.2%). During the follow-up period, recurrent HH after oesophagectomy requiring revisional surgery developed in 8 (6 days-26 months) patients. CONCLUSIONS Surgical management of HH after oesophagectomy could be done by laparoscopy in patients with scheduled surgery but laparotomy or thoracotomy was preferred in urgent situations. The incidence of HH after oesophagectomy is higher and its onset earlier when laparoscopy is used at the initial oesophagectomy.
Collapse
Affiliation(s)
- Lucile Gust
- Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France
| | - Philippe Nafteux
- Department of Thoracic Surgery and Disease of the Esophagus, KUZ Gathuisberg, Leuven, Belgium
| | - Pierre Allemann
- Department of Thoracic Surgery, University Hospital Vaudois, Lausanne, Switzerland
| | - Jean-Jacques Tuech
- Department of Visceral Surgery, Rouen University Hospital, Rouen, France
| | - Issam El Nakadi
- Department of Visceral Surgery, ULB-Erasme-Bordet University Hospital, Brussels, Belgium
| | - Denis Collet
- Department of Visceral and Endocrine Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Diane Goere
- Department of Visceral Surgery, Gustave Roussy Institute, Villejuif, France
| | - Jean-Michel Fabre
- Department of Visceral Surgery and Hepatic Transplantation, Montpellier University Hospital, Montpellier, France
| | - Bernard Meunier
- Department of Hepato-Biliary and Visceral Surgery, Rennes University Hospital, Rennes, France
| | - Frédéric Dumont
- Department of Oncological Surgery, Oncologic Institute of the West (Institut de Cancérologie de l'Ouest), Nantes, France
| | - Gilles Poncet
- Department of Visceral Surgery, Édouard-Heriot Hospital, Lyon, France
| | - Guillaume Passot
- Department of Visceral and Endocrine Surgery, Hospices Civils de Lyon-South Hospital, Lyon, France
| | - Nicolas Carrere
- Department of General and Visceral Surgery, Purpan University Hospital, Toulouse, France
| | - Muriel Mathonnet
- Department of General, Visceral and Endocrine Surgery, Dupuytren Hospital, Limoges, France
| | - Gil Lebreton
- Department of Visceral Surgery-Colo-rectal Surgery Unit, Caen University Hospital, Caen, France
| | - Jérémie Theraux
- Department of Visceral Surgery, Brest University Hospital, Brest, France
| | - Frédéric Marchal
- Department of Surgery, Lorraine Oncologic Institute, Nancy, France
| | - Gabriele Barabino
- Department of Visceral and Oncological Surgery, Saint-Étienne University Hospital, Saint-Etienne, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France
| | - Guillaume Piessen
- Department of General and Visceral Surgery, Lille University Hospital, Lille, France
| | - Xavier-Benoît D'Journo
- Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France
| |
Collapse
|
20
|
Iwasaki H, Tanaka T, Miyake S, Yoda Y, Noshiro H. Postoperative hiatal hernia after minimally invasive esophagectomy for esophageal cancer. J Thorac Dis 2020; 12:4661-4669. [PMID: 33145039 PMCID: PMC7578511 DOI: 10.21037/jtd-20-1335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Minimally invasive esophagectomy (MIE) can reduce various complications compared with conventional thoracotomic esophagectomy. However, several reports suggested that MIE promoted incidence of post-operative hiatal hernia (HH). In current reports, we retrospectively analyzed incidence and risk factors of HH development after MIE. Methods A total of 113 patients undergoing MIE (McKeown esophagectomy) at our institute from April 2009 to December 2015 were included in this study. Patients with clinical stage II and III received neoadjuvant chemotherapy (NAC). Results Eleven of 113 patients (9.7%) undergoing MIE developed HH. Four of them were female and the ratio of female among the patient with HH was higher than that among the patient without HH after MIE (36.4% vs. 13.7%, P=0.05). Sixty-six patients (58.4%) during the study period were administered NAC and 10 of 11 patients with HH (90.9%) received NAC according to the clinical stage, which was significantly more than in the non-HH group (P=0.02). Type and route of graft organ were not related to HH development. Moreover, the fixation of the conduit organ at the hiatus does not contribute to post-operative HH. Conclusions In the current study, we showed that NAC was a major risk factor of HH development after MIE.
Collapse
Affiliation(s)
- Hironori Iwasaki
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.,Department of Surgery, Saga University Hospital, Saga, Japan
| | - Tomokazu Tanaka
- Department of Surgery, Saga University Hospital, Saga, Japan
| | - Shuusuke Miyake
- Department of Surgery, Saga University Hospital, Saga, Japan.,Department of Surgery, Takagi Hospital, Fukuoka, Japan
| | - Yukie Yoda
- Department of Surgery, Saga University Hospital, Saga, Japan
| | | |
Collapse
|
21
|
Hanna AN, Guajardo I, Williams N, Kucharczuk J, Dempsey DT. Hiatal Hernia after Esophagectomy: An Underappreciated Complication? J Am Coll Surg 2020; 230:700-707. [PMID: 31954821 DOI: 10.1016/j.jamcollsurg.2019.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The natural history of hiatal herniation of small and/or large bowel post-esophagectomy (HHBPE) in the current era of improving long-term survival and evolving surgical technique is unknown. The aim of this study was to describe the rate and risk factors of HHBPE at our hospital. METHODS Patients undergoing esophagectomy between January 2011 and June 2017 were included if both follow-up information and axial imaging were available beyond 3 months post-esophagectomy. Patient characteristics, disease information, and treatment factors were all included in univariate analysis comparing patients with and without HHBPE, and multivariate regression was used to identify significant independent risk factors associated with HHBPE. RESULTS Of 310 esophagectomy patients analyzed, 258 patients were included in the study, with 79 patients (31%) showing evidence of an HHBPE and an overall median follow-up of 24 months; 44 of 79 patients (56%) had symptoms possibly referable to HHBPE and 17 of 79 patients (22%) underwent surgical repair. On univariate analysis, neoadjuvant therapy (n = 176), higher clinical stage, minimally invasive approach (n = 154), and transhiatal esophagectomy (n = 189) were significant predictors of HHBPE (p < 0.05). On multivariate analysis, neoadjuvant therapy and transhiatal approach remained significant independent predictors (p < 0.05). The rate of HHBPE was 44% in the 131 patients (51%) that had both factors. CONCLUSIONS HHBPE in the current era of neoadjuvant therapy and minimally invasive esophagectomy is common. HHBPE can cause gastrointestinal symptoms, but operation to repair HHBPE is uncommon on intermediate follow-up. Additional study and long-term follow-up are required to fully assess the impact of HHBPE and to potentially modify surgical practice to prevent or minimize HHBPE.
Collapse
Affiliation(s)
- Andrew N Hanna
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Isabella Guajardo
- Department of Surgery, University of California-San Diego, San Diego, CA
| | - Noel Williams
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - John Kucharczuk
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Daniel T Dempsey
- Department of Surgery, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
22
|
Abstract
BACKGROUND Enterothorax (ET) is a rare complication after hepatic surgery. The literature in this field is limited and mainly based on case reports. The aim of this study was to review our department's experience. PATIENTS AND METHODS We retrospectively analyzed 602 patients who underwent hepatic resection between November 2008 and December 2016. Major hepatic surgery (n = 321) was defined as right or extended right hepatectomy (n = 227), left or extended left hepatectomy (n = 63), trisegmentectomy (n = 13), and living donor liver transplantation (n = 18). ET cases were identified by analyzing clinical courses and radiological imaging. RESULTS ET was observed in five out of 602 patients (0.8%). All patients developed the complication after major hepatic surgery (five out of 321, 1.6%). ET exclusively occurred after right (n = 3) or extended right hepatectomy (n = 2). Median time to diagnosis was 22 months. Radiological imaging showed herniation of small (n = 2), large bowel (n = 2), or omental fat (n = 1) with a median diaphragmatic defect of 3.9 cm. Two patients presented with acute incarceration and underwent emergency surgery, one patient reported recurrent pain and underwent elective repair, and two patients refused surgery. Follow-up imaging in two operated patients showed no recurrence of ET after 36 and 8 months. CONCLUSIONS Patients after right hepatectomy have a substantial risk of ET. Acute right upper quadrant pain and/or dyspnea after hepatectomy should be investigated with adequate radiological imaging. Elective surgical repair of ET is recommended to avoid emergency surgery in case of incarceration.
Collapse
|
23
|
Minimally Invasive and Robotic Esophagectomy: A Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 13:391-403. [PMID: 30543576 DOI: 10.1097/imi.0000000000000572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Great advances have been made in the surgical management of esophageal disease since the first description of esophageal resection in 1913. We are in the era of minimally invasive esophagectomy. The current three main approaches to an esophagectomy are the Ivor Lewis technique, McKeown technique, and the transhiatal approach to esophagectomy. These operations were associated with a high morbidity and mortality. The recent advances in minimally invasive surgical techniques have greatly improved the outcomes of these surgical procedures. This article reviews the literature and describes the various techniques available for performing minimally invasive esophagectomy and robot-assisted esophagectomies, the history behind the development of these techniques, the variations, and the contemporary outcomes after such procedures.
Collapse
|
24
|
Rumination syndrome after esophagectomy. Eur Surg 2019. [DOI: 10.1007/s10353-018-0567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Sato T, Fujita T, Fujiwara H, Daiko H. Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports. Surg Case Rep 2019; 5:26. [PMID: 30778778 PMCID: PMC6379493 DOI: 10.1186/s40792-019-0578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Minimally invasive esophagectomy is considered a beneficial approach to esophageal cancer, although a hiatal hernia occurs more frequently in this approach than in open esophagectomy with reconstruction via the mediastinal route. Development of an internal hernia to the retrosternal space is not a recognized complication of reconstruction via the retrosternal route after esophagectomy. We herein report three cases of the development of an internal hernia to the retrosternal space after minimally invasive esophagectomy. Case presentation Thoracolaparoscopic esophagectomy with cervical anastomosis by retrosternal route reconstruction was performed in all three cases. All patients were men ranging in age from 60 to 80 years. Two patients had abdominal pain, and one had experienced syncope. All patients were diagnosed by computed tomography with an internal hernia to the retrosternal space and thoracic cavity (retrosternal hernia) without ischemic change to the incarcerated intestine. Two patients received medical therapy to relieve their intra-abdominal pressure, which allowed for a successful reduction of the intestine into the abdomen. Open laparotomy was performed to repair the hernia in the third patient. After reducing the intestine into the abdomen, reefing of the retrosternal orifice was performed, and the gastric conduit was anchored to the abdominal wall. No relapse occurred in three cases throughout follow-up. Conclusion Hiatal hernia is a well-recognized complication after minimally invasive esophagectomy; however, retrosternal hernia is a rare complication following this procedure. Based on the present report, if no ischemic change is present in the herniated intestine, two types of potentially curative treatments are available: medical or surgical. As minimally invasive esophagectomy is performed more frequently, retrosternal hernia may become an increasingly more common complication in the near future.
Collapse
Affiliation(s)
- Takuji Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hisashi Fujiwara
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| |
Collapse
|
26
|
Emergency Laparoscopic Repair of Giant Left Diaphragmatic Hernia following Minimally Invasive Esophagectomy: Description of a Case and Review of the Literature. Case Rep Surg 2018; 2018:2961517. [PMID: 30298114 PMCID: PMC6157200 DOI: 10.1155/2018/2961517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/07/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. PDH occurs more frequently when minimally invasive techniques are employed, but very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 71-year-old man underwent minimally invasive esophagectomy for esophageal cancer. Three months later, he developed a giant PDH, which was repaired by direct suture via laparoscopic approach. A hypertensive pneumothorax occurred during surgery. This complication was managed by the anaesthesiologist through a high fraction of inspired O2 and several recruitment manoeuvres. The patient remained free of hernia recurrence until he died of neoplastic cachexia 5 months later. Laparoscopic repair of PDH may be safe and effective even in the acute setting and in the case of massive herniation. However, surgeons and anaesthesiologists should be aware of the risk of intraoperative pneumothorax and be prepared to treat it promptly.
Collapse
|
27
|
Laliotis A, Hettiarachchi T, Rashid F, Hindmarsh A, Sujendran V. Mediastinal herniation of the biliary tract leading to bile duct: obstruction following oesophagectomy. Ann R Coll Surg Engl 2018; 100:e1-e3. [PMID: 30112944 PMCID: PMC6204511 DOI: 10.1308/rcsann.2018.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 11/22/2022] Open
Abstract
Surgical management of oesophageal and gastro-oesophageal junction malignancies is one of the most challenging situations confronting the surgeon. Attaining a complete circumferential resection margin of lower-third oesophageal and gastro-oesophageal junction locally advanced carcinomas requires en-bloc resection of the hiatus and all the peri-oesophageal tissue and pleura. This results in an increased risk of herniation of the abdominal organs through the enlarged hiatus, which carries significant risk of morbidity and mortality. The incidence of this complication is higher than has been reported. Surgical management of symptomatic hernias is the standard treatment while criteria for managing asymptomatic hernias are less clear. We report a rare case of a late mediastinal herniation of the pancreas and bile duct, leading to obstructive jaundice following oesophagectomy which was treated successfully in our unit.
Collapse
Affiliation(s)
- A Laliotis
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals
NHS Foundation Trust, Hills Rd, Cambridge, UK
| | - T Hettiarachchi
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals
NHS Foundation Trust, Hills Rd, Cambridge, UK
| | - F Rashid
- Luton and Dunstable University Hospital NHS Foundation Trust, Department of Surgery, Luton, UK
| | - A Hindmarsh
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals
NHS Foundation Trust, Hills Rd, Cambridge, UK
| | - V Sujendran
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals
NHS Foundation Trust, Hills Rd, Cambridge, UK
| |
Collapse
|
28
|
Incidence and Treatment of Symptomatic Diaphragmatic Hernia After Esophagectomy for Cancer. Ann Thorac Surg 2018; 106:199-206. [DOI: 10.1016/j.athoracsur.2018.02.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 12/14/2022]
|
29
|
Rove JY, Krupnick AS, Baciewicz FA, Meyers BF. Gastric conduit revision postesophagectomy: Management for a rare complication. J Thorac Cardiovasc Surg 2017; 154:1450-1458. [DOI: 10.1016/j.jtcvs.2017.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
|
30
|
Akiyama Y, Iwaya T, Endo F, Chiba T, Takahara T, Otsuka K, Nitta H, Koeda K, Mizuno M, Kimura Y, Sasaki A. Laparoscopic repair of parahiatal hernia after esophagectomy: a case report. Surg Case Rep 2017; 3:91. [PMID: 28831761 PMCID: PMC5567583 DOI: 10.1186/s40792-017-0367-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/17/2017] [Indexed: 01/27/2023] Open
Abstract
Background Diaphragmatic hernia is a potential complication of esophagectomy, which usually occurs as a hiatal hernia and more frequently after minimally invasive esophagectomy. Parahiatal hernia is a rare form of diaphragmatic hernia, and to the best of our knowledge, parahiatal hernia after esophagectomy has not been previously reported. Here, we report a case of parahiatal hernia after esophagectomy that was successfully managed laparoscopically. Case presentation A 73-year-old man underwent thoracoscopic esophagectomy for esophageal cancer with gastric tube reconstruction via the posterior mediastinum. Postoperative morbidity was ileus, which required conservative treatment, and intestinal obstruction for which operation with laparotomy was necessary. He was admitted with abdominal pain and vomiting at 15 months after esophagectomy. Abdominal X-ray revealed colon gas in the intrathoracic space. A barium enema examination showed a transverse colon incarcerated in the intrathoracic space. The patient was preoperatively diagnosed with hiatal hernia after esophagectomy, and laparoscopic hernia repair was performed. During the surgery, the hiatus was found to be intact, and the defect was clearly separated from the left crus of the diaphragm. Parahiatal hernia was the operative diagnosis. The incarcerated colon was repositioned in the abdominal cavity, and the defect was repaired using a composite mesh. Conclusions Laparoscopic surgery was found to be effective for the diagnosis and repair of parahiatal hernia.
Collapse
Affiliation(s)
- Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Fumitaka Endo
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takehiro Chiba
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masaru Mizuno
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yusuke Kimura
- Department of Palliative Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| |
Collapse
|
31
|
Sun Y, Yin L, Xue H, Wang H, Li Z, Yu J. Unusual delayed presentation of diaphragmatic hernia complicated by transverse colon and total small-bowel obstruction after postoperative chemotherapy of esophageal cancer. Ther Clin Risk Manag 2017; 13:691-695. [PMID: 28652754 PMCID: PMC5472414 DOI: 10.2147/tcrm.s135677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diaphragmatic hernia (DH) is defined as the passage of abdominal contents into the chest cavity through a defect in the diaphragm. DH occurs after chest or abdominal surgery, and is very rare and sporadically reported in the literature. However, the complications are significant and put the patient at great risk. The aim of the present report was to describe a special case with postesophagectomy diaphragmatic hernia (PDH) because of its appearance during chemotherapy and confusion of the symptoms with the side effects of chemotherapy. A high index of suspicion needs to be maintained in clinical practice.
Collapse
Affiliation(s)
- Yanlai Sun
- Post-doctoral Research Station, Tianjin Medical University, Tianjin.,Department of Gastrointestinal Cancer Surgery
| | - Lei Yin
- Department of Gastrointestinal Cancer Surgery
| | - Hongfan Xue
- Department of Gastrointestinal Cancer Surgery
| | | | - Zengjun Li
- Department of Gastrointestinal Cancer Surgery
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| |
Collapse
|
32
|
Brenkman HJF, Parry K, Noble F, van Hillegersberg R, Sharland D, Goense L, Kelly J, Byrne JP, Underwood TJ, Ruurda JP. Hiatal Hernia After Esophagectomy for Cancer. Ann Thorac Surg 2017; 103:1055-1062. [PMID: 28267979 DOI: 10.1016/j.athoracsur.2017.01.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/04/2016] [Accepted: 01/05/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE). METHODS The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH. RESULTS Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p = 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p < 0.001). In-hospital deaths were solely seen after emergency operations (19%). CONCLUSIONS HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.
Collapse
Affiliation(s)
- Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kevin Parry
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Fergus Noble
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | | | - Donna Sharland
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jamie Kelly
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - James P Byrne
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Timothy J Underwood
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
33
|
Kim D, Kim SW, Hong JM. Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:306-8. [PMID: 27525243 PMCID: PMC4981236 DOI: 10.5090/kjtcs.2016.49.4.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/05/2016] [Accepted: 02/12/2016] [Indexed: 11/23/2022]
Abstract
Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common.
Collapse
Affiliation(s)
- Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University College of Medicine
| | - Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University College of Medicine
| | - Jong-Myeon Hong
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University College of Medicine
| |
Collapse
|
34
|
Crus incision without repair is a risk factor for esophageal hiatal hernia after laparoscopic total gastrectomy: a retrospective cohort study. Surg Endosc 2016; 31:237-244. [DOI: 10.1007/s00464-016-4962-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/28/2016] [Indexed: 12/15/2022]
|
35
|
Oor JE, Wiezer MJ, Hazebroek EJ. Hiatal Hernia After Open versus Minimally Invasive Esophagectomy: A Systematic Review and Meta-analysis. Ann Surg Oncol 2016; 23:2690-8. [DOI: 10.1245/s10434-016-5155-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 12/17/2022]
|
36
|
Gonzalo MA, Almeida H, Güemes A. Hiatal herniation following total gastrectomy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:234. [PMID: 26911996 DOI: 10.17235/reed.2016.4009/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors present a case of early hiatal hernia (HH), 30 days after surgery, that recurred a week after. Our purpose in this case report is to discuss briefly the potential cause and to enhance the importance of CT.
Collapse
|
37
|
Crespin OM, Farjah F, Cuevas C, Armstrong A, Kim BT, Martin AV, Pellegrini CA, Oelschlager BK. Hiatal Herniation After Transhiatal Esophagectomy: an Underreported Complication. J Gastrointest Surg 2016; 20:231-6. [PMID: 26589526 DOI: 10.1007/s11605-015-3033-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/13/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The incidence and presentation of hiatal hernias after esophagectomy (HHAE) are not well characterized, and may be changing with increased survival from esophageal cancer. The aims of this study were to define the incidence and presentation of HHAE in our population of patients undergoing transhiatal esophagectomy (THE), as it may have implications for management. METHODS A retrospective cohort study (2004-2013) was performed of esophageal cancer patients who underwent THE. To determine the presence or absence of HHAE independent of the original radiology report, a radiologist sub-specializing in body imaging independently reviewed post-operative computed tomography images. A time-to-event competing risk analysis was performed to estimate the cumulative incidence of HHAE. RESULTS Among 192 patients, the two-year cumulative incidence of HHAE was 14 % (95 % confidence interval 7.5-21 %). Of the 22 patients determined to have HHAE by independent expert radiologist review, only 11 (50 %) were identified by the original interpreting radiologist. Seven patients were symptomatic, and each underwent hiatal hernia repair (4 via laparotomy, 3 via laparoscopy). CONCLUSION HHAE is not rare and is often unrecognized. As more patients with esophageal cancer survive, the number of patients becoming symptomatic and requiring repair may also rise. Therefore, it is important to consider this diagnosis when following patients long-term after esophagectomy.
Collapse
Affiliation(s)
- Oscar M Crespin
- Department of Surgery, University of Washington, Seattle, WA, USA.
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA, USA.,Surgical Outcomes Research Center, University of Washington, Seattle, WA, USA
| | - Carlos Cuevas
- Department of Radiology Seattle, University of Washington, Seattle, WA, USA
| | | | - Bryan T Kim
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Ana V Martin
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | | |
Collapse
|
38
|
Diaphragmatic hernia following oesophagectomy for oesophageal cancer - Are we too radical? Ann Med Surg (Lond) 2016; 6:30-5. [PMID: 27158485 PMCID: PMC4843099 DOI: 10.1016/j.amsu.2015.12.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/31/2015] [Accepted: 12/31/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. METHODS We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. DISCUSSION Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. CONCLUSION This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity.
Collapse
|
39
|
Narayanan S, Sanders RL, Herlitz G, Langenfeld J, August DA. Treatment of Diaphragmatic Hernia Occurring After Transhiatal Esophagectomy. Ann Surg Oncol 2015; 22:3681-3686. [DOI: 10.1245/s10434-015-4366-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
40
|
Prasad KK, Chaudhary RK. Post Esophagectomy Hiatal Hernia; Expect the Unexpected. J Clin Diagn Res 2015; 9:XL01. [PMID: 26501000 DOI: 10.7860/jcdr/2015/14161.6527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Karthik Krishna Prasad
- Senior Resident, Department of Surgical Oncology, HCG- Bharat Hospital and Institute of Oncology , Mysore, Karnataka, India
| | - Rahul Kumar Chaudhary
- Consultant, Department of Surgical Oncology, HCG- Bharat Hospital and Institute of Oncology , Mysore, Karnataka, India
| |
Collapse
|
41
|
Ulloa Severino B, Fuks D, Christidis C, Denet C, Gayet B, Perniceni T. Laparoscopic repair of hiatal hernia after minimally invasive esophagectomy. Surg Endosc 2015; 30:1068-72. [DOI: 10.1007/s00464-015-4299-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
|
42
|
Benjamin G, Ashfaq A, Chang YH, Harold K, Jaroszewski D. Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature. Hernia 2015; 19:635-43. [DOI: 10.1007/s10029-015-1363-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/20/2015] [Indexed: 01/25/2023]
|
43
|
Diaphragmatic herniation after thoracolaparoscopic esophagectomy for carcinoma of the esophagus: a report of six cases. Esophagus 2015. [DOI: 10.1007/s10388-015-0485-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
44
|
|
45
|
Messenger DE, Higgs SM, Dwerryhouse SJ, Hewin DF, Vipond MN, Barr H, Wadley MS. Symptomatic diaphragmatic herniation following open and minimally invasive oesophagectomy: experience from a UK specialist unit. Surg Endosc 2014; 29:417-24. [DOI: 10.1007/s00464-014-3689-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/14/2014] [Indexed: 11/28/2022]
|
46
|
Bronson NW, Luna RA, Hunter JG, Dolan JP. The incidence of hiatal hernia after minimally invasive esophagectomy. J Gastrointest Surg 2014; 18:889-93. [PMID: 24573659 DOI: 10.1007/s11605-014-2481-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 02/10/2014] [Indexed: 01/31/2023]
Abstract
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.
Collapse
Affiliation(s)
- Nathan W Bronson
- Department of Surgery, Oregon Health & Science University, Mail Code L223A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA,
| | | | | | | |
Collapse
|