Diaphragmatic herniation after transhiatal esophagectomy

Abstract

Increasing experience with transhiatal esophagectomy (THE) has brought with it a good understanding of the advantages and disadvantages of the technique. As in our case, diaphragmatic hernias after THE may result from excess manipulation and extension of the hiatus during surgery. The varying nature of the clinical presentation may cause delay in diagnosis. We report our case and discuss how to diagnose and manage this complication under the sum of cases reported previously in English literature.

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

“…One of the complications of esophagectomy is para-gastric diaphragmatic herniation of abdominal viscera. In minimally invasive surgery, adhesion formation is reduced as compared to open technique and so, theoretically, the laparoscopic approach increases the risk of herniation [7,8].…”

Diaphragmatic herniation after esophagectomy for carcinoma of the esophagus: a report of two cases

“…In our institution, the mediastinal route is preferred after esophagectomy, and incidence of diaphragmatic herniation after esophagectomy was 1% (2/168). To date, 30 cases of diaphragmatic herniation after esophagectomy for carcinoma of the esophagus have been reported in the English-language literature (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13]. Our reports of diaphragmatic herniation after esophagectomy are, to our knowledge, the fi rst from Japan in the English-language literature.…”

Diaphragmatic hernia after minimally invasive esophagectomy

“…Specific approaches include a transhiatal route for esophageal dissection using laparoscopy, and a combined laparoscopic and thoracoscopic approach. Diaphragmatic hernia after open transhiatal surgery is an uncommon complication, although it has been described previously 1 . In our case report, we describe the development of a major diaphragmatic hernia after esophagectomy performed using a combined laparoscopic and thoracoscopic approach.…”

“…This patient presented with intermittent small bowel obstruction, which initially was not easily recognized, because the vomiting was construed as being a complication of chemotherapy. Diagnostic delay is a common feature of cases described after open surgery 1 . Of course, any obstructive symptoms may be due to recurrent cancer and this needs to be considered before undertaking repair of the diaphragmatic hernia.…”