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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002. 346:1128–1137
Singh RK, Pham TH, Diggs BS, Perkins S, Hunter JG. Minimally invasive esophagectomy provides equivalent oncologic outcomes to open esophagectomy for locally advanced (stage II or III) esophageal carcinoma. Arch Surg. 2011;146(6):711-714
Ben-David K, Sarosi GA, Cendan JC, Howard D, Rossidis G, Hochwald SN. Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies. Surg Endosc 2011; electronic publication ahead of print, July 2011.
Mamidanna R, Bottle A, Aylin P, Faiz O, Hanna GB. Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 2012 Feb;255(2):197-203
Van Sandick JW, Knegjens JL, van Lanschot JJ, Obertop H. Diaphragmatic herniation following oesophagectomy. Br J Surg 1999; 86:109 –12.
Vallböhmer D, Hölscher AH, Herbold T, Gutschow C, Schröder W. Diaphragmatic hernia after conventional or laparoscopic-assisted transthoracic esophagectomy. Ann Thorac Surg 2007;84:1847–53
Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation? Ann of Surg. 2002; 236 (4): 492-501.
Sutherland J, Banerji N, Morphew J, Johnson E, Dunn D. Postoperative incidence of incarcerated hiatal hernia and its prevention after robotic transhiatal esophagectomy. Surg Endosc 2011; 25: 1526-1530.
Kent MS, Luketich JD, Tsai W, Churilla P, Federle M, Landreneau R, Alvelo-Rivera M, Schuchert M. Revisional surgery after esophagectomy: an analysis of 43 patients. Ann Thorac Surg 2008; 86: 975– 83.
Willer BL, Worrell SG, Fitzgibbons RJ, Mittal SK. Incidence of diaphragmatic hernias following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy. Hernia (2012) 16:185–190.
Ganeshan DM, Correa AM, Bhosale P, Vaporciyan AA, Rice D, Mehran RJ, Walsh GL, Iyer R, Roth JA, Swisher SG, Hofstetter WL. Diaphragmatic hernia after esophagectomy in 440 patients with long-term follow-up. Ann Thor Surg 2013; 96:1138-45
Ganeshan DM, Bhosale P, Munden RF, Hofstetter WL, Correa AM, Iyer R. Diaphragmatic hernia after esophagectomy for esophageal malignancy. J Thorac Imaging 2013; 28: 308-314.
Aly A, Watson DI. Diaphragmatic hernia after minimally invasive esophagectomy. Dis of the Esoph 2004; 17: 183–186
Balázs A, Forgács A, Flautner L, Kupcsulik P. A case of unusual complication of diaphragmatic herniation of the transverse colon following transhiatal esophagectomy. Orv Hetil 1997;138:2535– 8.
Audebert A, Wind P, Sauvanet A, Douard R, Benichou J, Cugnenc PH, Belghiti J. Diaphragmatic hernia is a rare complication of esophagectomy for cancer. Ann Chir 2005;130:21–5.
Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011 Oct;213(4):461-8.
Ganeshan DM, Bhosale P, Munden RF, Hofstetter WL, Correa AM, Iyer R. Diagnosing diaphragmatic hernia after esophagectomy for esophageal malignancy ,J Thorac Imaging 2013;28:308–314
Acknowledgments
This work was supported by a training grant from NIH/NIGMS (T32 GM082770).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bronson, N.W., Luna, R.A., Hunter, J.G. et al. The Incidence of Hiatal Hernia After Minimally Invasive Esophagectomy. J Gastrointest Surg 18, 889–893 (2014). https://doi.org/10.1007/s11605-014-2481-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-014-2481-9