Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases

Takeda, Flávio Roberto; Tustumi, Francisco; Filho, Marco A. Santo; Silva, Matheus O.; Júnior, Ulysses Ribeiro; Sallum, Rubens Antônio Aissar; Cecconello, Ivan

doi:10.1089/lap.2019.0596

Cited by 7 publications

(2 citation statements)

References 7 publications

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“…This strategy follows the hypotheses, that the hernia may be progressive in size and symptoms, thus symptoms may arise in initially asymptomatic patients and an early elective hernia repair might prevent patients from severe cardiac, pulmonary and bowel complications as well as the fatal risk of incarceration with obstruction or perforation in the emergency situation [ 10 , 15 , 17 , 30 , 31 ]. By that way, no predictors are known for an unfavorable outcome of conservative “wait-and-see” strategies, thus a great proportion of patients require emergency surgery although an initially intended “wait-and-see” concept [ 14 , 28 , 30 , 39 ]. Thereby, it is known that not only morbidity rates of the patients (up to 60%) with consecutively longer hospital stays but also mortality rates (up to 20%) are dramatically increased after hernia repair in the emergency situation [ 11 , 14 , 15 , 20 , 28 , 29 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Kent et al recommend preservation of the peritoneal lining and dorsal mobilization of the crura for tension-free adaptation [ 40 , 42 ]. Additional mesh augmentation can be performed after suture cruroplasty of larger defects similar to paraesophageal hernia repair [ 8 , 16 , 39 , 43 , 44 ]. Furthermore, some authors recommend the fixation of the conduit to the crus or pexy of abdominal organs, especially of the transverse colon as the most often prolapsed organ as an additional measure [ 10 , 14 , 16 , 19 , 32 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

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

Oppelt

Askevold

Hörbelt

et al. 2021

Hernia

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Oppelt

Askevold

Hörbelt

et al. 2021

Hernia

View full text Add to dashboard Cite

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Internal and Congenital Hernias

Tebala,

Ceriati,

Ali

et al. 2023

Mini-Invasive Approach in Acute Care Surgery

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Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

Bona

Lombardo

Matsushima

et al. 2021

Langenbecks Arch Surg

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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.

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Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases

Cited by 7 publications

References 7 publications

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

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

Internal and Congenital Hernias

Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

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