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

Abstract

There was a significantly higher incidence of para-gastric hiatal hernia after Ivor Lewis McKeown minimally invasive esophagectomy compared to similar open procedures. Additional precautions to prevent para-gastric hernia should be taken during laparoscopic resection.

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

“…Diaphragmatic herniation after an esophagectomy is a complication with reported incidence ranging from 0.4 to 15 % [4,6,7,10,11,13,20]. In our literature search, the mean published incidence was 2.6 % post-esophagectomy [2][3][4][5][6][7][10][11][12][13][14].…”

“…In our literature search, the mean published incidence was 2.6 % post-esophagectomy [2][3][4][5][6][7][10][11][12][13][14]. The true incidence is likely underestimated due to the limited long-term survival occurring in the esophageal cancer patient population [16,22].…”

“…Diaphragmatic hernia was noted in several studies to occur in a bi-modal distribution: either early in the postoperative period or as a late complication [18]. It has been postulated that minimally invasive techniques result in a lesser amount of intra-abdominal postoperative adhesions when compared to open approaches thereby increasing the risk of developing a hernia [4,6,10,11,19] in the early postoperative period. In the longer term, a hernia could result from a progressive hiatal dilation that occurs from a higher intra-abdominal pressure, forcing contents into the chest [6,10].…”

“…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.…”

“…The overall incidence of DH may be underestimated given the limited follow-up and high disease recurrence of the post-esophagectomy patient. DH may occur at a higher incidence after MIE when compared to open procedures [2][3][4][5][6]. An evaluation of our institution's incidence of post-MIE DH was performed in addition to a review of the published literature regarding DH after both open and minimally invasive esophagectomy.…”