Diaphragmatic Hernia After Totally Laparoscopic Total Gastrectomy for Gastric Cancer

Abstract

This study aimed to investigate the occurrence of diaphragmatic hernia (DH) after totally laparoscopic total gastrectomy (TLTG) for gastric cancer. We reviewed retrospectively collected data from 490 consecutive patients who underwent TLTG (functional method, 365; overlap method, 125) for upper body gastric cancer, between January 2011 and May 2017, performed by a single surgeon. The median follow-up period was 40.6 months. Of 490 patients, 8 (1.63%) developed DH at a mean interval after TLTG of 7.3 (range, 3.4 to 12.8) months. All 8 patients were from the functional group, and presented with abdominal pain or vomiting. They were managed with emergency surgery (5 laparoscopic hernia reduction, 3 open hernia reduction). The grade of complication according to Clavien-Dindo classification (CDC) was CDC-III in 7 cases and CDC-IV in 1 case. There was no death associated with DH complications. None of the patients in the overlap group developed DH. The incidence of DH after TLTG is negligible in the overlap method. Therefore, the overlap method may be a safe reconstruction technique that can reduce the occurrence of DC after TLTG for gastric cancer.

Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

“…These lead consecutively to a loss of functional anatomy of the hiatus. Additionally, a lower BMI (< 25 kg/m 2 ) or excessive weight loss after index surgery facilitates the mobility of intra-abdominal viscera and diabetes as well as neoadjuvant therapy impair wound healing [ 10 , 11 , 14 , 17 , 22 , 30 , 32 , 36 ]. However, several measures have been described in the literature to restore hiatal function during index surgery in the hope to reduce the incidence of HH after esophago-gastric surgery, but data on their efficacy are still lacking: direct closure of the diaphragmatic defect anteriorly (because the conduit lies posteriorly) and/or posteriorly, fixation of the conduit to the crura, mesh interposition, colopexy or omentopexy in front of the hiatus [ 9 – 11 , 13 , 15 – 19 , 34 , 37 , 38 ].…”

“…The current literature agrees, that patients with severe and acute onset of symptoms should undergo urgent or emergency surgery for hernia repair [ 7 , 10 , 17 ]. Thereby, CT is an adequate technique in the elective as well as emergency situation for diagnosis of the hernia and assessment of possible hernia-associated complications of the prolapsed contents such as incarceration, strangulation or perforation [ 10 , 11 , 14 , 30 , 31 , 36 ]. Fuchs et al and Sutherland et al described hernia-associated bowel complications in approximately one-third of the patients [ 10 , 37 ].…”

“…Finally, the inhomogeneous patient collective regarding index surgeries leads to some differences in hernia characteristics and thus should be interpreted as a minor limitation. Thereby, the current literature reveals the lowest incidence for trans-hiatal herniation after conventional gastrectomy [ 13 , 28 , 32 , 36 ], since in these cases other types of internal hernia, like Peterson´s hernia or herniation through the jejunojejunostomy mesenteric defect after Roux-Y reconstruction, are more frequent [ 13 , 36 , 45 – 47 ]. Thus, the group of patients, who initially underwent total gastrectomy with Roux-Y reconstruction, seems a bit overrepresented in our cohort.…”