Diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy

Abstract

Minimally invasive techniques are increasingly being used for oesophagectomy. Diaphragmatic hernia is a rare complication of gastroplasty in open surgery. One of the advantages of the laparoscopic technique, the lack of peritoneal adhesions, may lead to an increased rate of this complication. We report two cases of diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy out of a series of 44 laparoscopic gastroplasties performed over 33 months. We discuss some technical aspects related to its occurrence. Prevention should include a limited crural division and fixation of the gastric tube to the diaphragmatic crura at primary surgery.

Incidence of diaphragmatic hernias following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy

“…Hiatal herniation occurs as a result of a combination of factors, including negative intra-thoracic and positive intra-abdominal pressure. Peritoneal adhesions that form as a result of abdominal surgery serve to anchor abdominal viscera and secure the hiatus around the conduit but in their absence, the viscera are drawn superiorly and progressively dilate the defect, facilitating their herniation into the thorax [7,9]. This may come into play in laparoscopic surgery, where adhesion formation is reduced in comparison to open surgery and may predispose to an increased risk of herniation following minimally invasive approaches.…”

“…Hiatal herniation following esophagectomy is rare. The incidence has been reported as 0.4-2% following open resection, but may be as high as 6% with long-term follow up [9]. Patients with a hiatal hernia may be asymptomatic, with the only indication of herniation being radiographic evidence spotted on postoperative surveillance for tumor recurrence [10].…”

“…Patients with a hiatal hernia may be asymptomatic, with the only indication of herniation being radiographic evidence spotted on postoperative surveillance for tumor recurrence [10]. On the other hand, presentation may range from respiratory distress, chest pain, abdominal pain, intestinal obstruction and/or strangulation, and gastrointestinal bleeding [7,9]. Given the variety of presentations, diagnosis may be difficult.…”

Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature

“…The long-term results of MIE are just beginning to be documented, including potential complications of DH [2][3][4][5][6][7]. The overall incidence of DH may be underestimated given the limited follow-up and high disease recurrence of the post-esophagectomy patient.…”

Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?

“…There are cited disadvantages, including higher rates of gastric conduit necrosis and anastomotic leak [5,6]. In addition, there are increasing reports of diaphragmatic herniation following esophagectomy performed using minimally invasive techniques [7,8].…”