Clinical Impact of Intrathoracic Herniation of Gastric Tube Pull-Up via the Retrosternal Route following Esophagectomy

Abstract

Background: Intrathoracic herniation of gastric tube (IHGT) pull-up via the retrosternal route is a rare complication following esophagectomy, which is caused due to an injury in the parietal pleura during a blunt dissection of the retrosternal space. However, little is known regarding the clinical impact of IHGT pull-up via the retrosternal route. Patients and Methods: Clinical data of 231 patients receiving gastric tube reconstruction via the retrosternal route following esophagectomy were collected from medical charts. Results: Of the 231 patients, 19 (8%) developed IHGT. Vocal cord palsy, particularly with delayed onset, developed at a significantly high frequency in the group of patients with IHGT. There were no significant differences in the frequency of other surgical complications. Conclusion: This is the first report to examine the clinical impact of IHGT pull-up via the retrosternal route. Vocal cord palsy, particularly with delayed onset, developed in the group of patients with IHGT. Therefore, when reconstruction is performed via the retrosternal route, it is very important that blunt and blind dissection of the retrosternal space be performed with extreme care to prevent pleural injury.

Intrathoracic herniation of retrosternal gastric conduit after thoracolaparoscopic esophagectomy causing gastric conduit obstruction: A case report

“…IHGC following esophagectomy with retrosternal reconstruction is an uncommon complication; a retrospective study on 231 patients shows a rate of 8 % [ 3 ]. The mechanism is explained by the injury in the parietal pleura during a blunt dissection of the retrosternal space.…”

“…Intrathoracic herniation of gastric conduit (IHGC) is an uncommon complication following esophagectomy. IHGC significantly impacts clinical outcomes due to secondary complications such as anastomotic leak, pneumonia, gastric conduit obstruction, malnutrition, and recurrent laryngeal nerve palsy [ 3 ]. However, little is known regarding managing IHGC after tri-incisional esophagectomy with gastric conduit pull-up via the retrosternal route.…”

Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports

“…One risk factor that differs is injury to the mediastinal pleura induced by negative pressure derived from the thoracic cavity. Uemura et al [4] concluded that injury to the mediastinal pleura introduces the reconstructed organ to the thoracic cavity by the negative pressure of breathing. We used the gastric tube as the reconstructed organ in the three patients described in the present report, but the intestine was drawn into the thoracic cavity by the retrosternal route.…”

“…To prevent a retrosternal hernia after MIE, close attention must be paid to the procedure by which the retrosternal route is established. Uemura et al [4] concluded that the use of a video-assisted maneuver might prevent injury to the parietal pleura during blunt dissection of the retrosternal space. Based on our cases, the retrosternal orifice should not be opened widely.…”

“…The retrosternal route is one reconstruction route that may be used after esophagectomy. Intrathoracic herniation of reconstructed organs was reported by Takayama et al [3] and Uemura et al [4], but no reports have described the incarceration of intestinal tissues other than reconstructed organs in the retrosternal space and thoracic cavity. We herein report three cases of internal hernia to the retrosternal space (hereafter called retrosternal hernia) after MIE.…”