Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports

Abstract

Background Minimally invasive esophagectomy is considered a beneficial approach to esophageal cancer, although a hiatal hernia occurs more frequently in this approach than in open esophagectomy with reconstruction via the mediastinal route. Development of an internal hernia to the retrosternal space is not a recognized complication of reconstruction via the retrosternal route after esophagectomy. We herein report three cases of the development of an internal hernia to the retrosternal space after minimally invasive esophagectomy. Case presentation Thoracolaparoscopic esophagectomy with cervical anastomosis by retrosternal route reconstruction was performed in all three cases. All patients were men ranging in age from 60 to 80 years. Two patients had abdominal pain, and one had experienced syncope. All patients were diagnosed by computed tomography with an internal hernia to the retrosternal space and thoracic cavity (retrosternal hernia) without ischemic change to the incarcerated intestine. Two patients received medical therapy to relieve their intra-abdominal pressure, which allowed for a successful reduction of the intestine into the abdomen. Open laparotomy was performed to repair the hernia in the third patient. After reducing the intestine into the abdomen, reefing of the retrosternal orifice was performed, and the gastric conduit was anchored to the abdominal wall. No relapse occurred in three cases throughout follow-up. Conclusion Hiatal hernia is a well-recognized complication after minimally invasive esophagectomy; however, retrosternal hernia is a rare complication following this procedure. Based on the present report, if no ischemic change is present in the herniated intestine, two types of potentially curative treatments are available: medical or surgical. As minimally invasive esophagectomy is performed more frequently, retrosternal hernia may become an increasingly more common complication in the near future.

Internal Hernia Through a Mesenteric Defect Following Esophagectomy and Reconstruction With a Stomach-Preserved Ileocolic Interposition

“…Studies have shown that the prevalence of post-esophagogastric surgery hiatal hernia is 3.18%, whereas that of hiatal hernia requiring surgical treatment is 2.01% [ 5 ]. Reports of other less common internal hernias in the retrosternal space have been published [ 6 - 8 ]. In recent years, minimally invasive techniques have become increasingly popular for esophageal cancer surgery.…”

Retrosternal herniation of transverse colon following minimal invasive esophagectomy causing dysphagia: A case report

“…Retrosternal hernia, an internal hernia where abdominal organs such as the small intestine or colon protrude through the opening of the retrosternal space into the chest, is a rare complication with limited reports. Takuji Sato et al reported three cases of retrosternal herniation after minimally invasive esophagectomy between January 2014 and December 2016 [ 9 ]. The interval between surgery and hernia detection varies in cases of hiatal hernia, typically ranging from 2.3 to 28.8 months [ 8 , 10 ].…”

“…The interval between surgery and hernia detection varies in cases of hiatal hernia, typically ranging from 2.3 to 28.8 months [ 8 , 10 ]. In the reported Japanese cases, the detection time ranged from 413 to 731 days, representing the latest instances requiring surgical intervention [ 9 ]. In our case, the hernia was discovered after four years, possibly attributable to the patient's irregular follow-up visits.…”

“…Nevertheless, using mesh can result in severe complications for the gastric graft, such as intraluminal mesh erosion, esophageal stenosis, and dense fibrosis. Another point is that no existing available literature exists about using mesh close for herniation after esophagectomy [ 9 , [11] , [12] , [13] ]. Therefore, we opted to perform primary closure without mesh.…”

Usefulness of delta neutrophil index as a biomarker to predict postoperative complication in patients who underwent esophagectomy

“…Esophagectomy is an established surgical procedure for the treatment of various benign and malignant lesions of the esophagus [ 1 ] Since the esophagus is located deep in the posterior midline of the mediastinum, and esophagectomy often involves extensive ranges of surgical regions such as the thorax, abdomen, and neck, this procedure is highly complex and invasive, and thus associated with a high incidence of complications. [ 2 , 3 ] The complications after esophagectomy vary, from common respiratory complications like pneumonia to less common complications such as pericarditis. [ 1 , 2 ] In particular, anastomotic leakage, with incidences ranging from 0 to 40%, is the most life-threatening complication associated with prolonged hospital stay and increased health care costs.…”