Diaphragmatic herniation following total gastrectomy: review of the long-term experience of a tertiary institution

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

“…The most frequently prolapsed organ is transverse colon into the left chest (literature review in Table 5 ). Therefore, some risk factors for trans-hiatal hernia development after esophagectomy or gastrectomy can be found in the present patient cohort, including pre-existing hiatal hernia (which were present in three of five patients from the gastrectomy group), iatrogenic enlargement of the hiatus and diaphragmatic crus incision—especially of the left one, without resection, violence to the left pleura and higher tumor stages, especially of carcinoma of the esophago-gastric junction making crus resection necessary [ 7 , 10 , 11 , 13 – 19 , 21 – 23 , 28 – 32 , 34 – 37 ]. 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 ].…”

“…Nevertheless, most articles in the current literature report a mixture of these techniques for hernia repair resulting in high recurrence rates, up to 38%, which, however, might be independently from mesh buttressing of suture cruroplasty [ 17 , 19 , 20 , 28 , 42 ]. Thereby care has to be taken on the blood supply of the jejunal limb or the gastric conduit from the right gastroepiploic artery after gastrectomy or esophagectomy, respectively, and not to obstruct the passage, which both can increase the risk for conduit necrosis and anastomotic leakages especially in cases of hiatal hernia repair in the early phase after gastrectomy or esophagectomy [ 9 – 11 , 13 , 16 – 21 , 34 ]. The use of meshes to restore the integrity of the hiatus during the index surgery is still disputed due to the additional feared risk of erosion of the conduit [ 9 , 10 , 13 , 16 – 19 , 34 ].…”

“…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.…”

Risk of diaphragmatic hernia in patients with spontaneous pneumothorax

“…In addition to iatrogenic diaphragmatic hernia (DH) [5,6], congenital DH is a common structural birth defect that affects approximately 1 in 2500 live births and usually related to lung hypoplasia and persistent pulmonary hypertension [7]. Although the exact mechanism of the congenital DH was not well demonstrated, it is becoming increasingly clear that genetic factors play an important role in many cases of congenital DH [7].…”