Intrathoracic Hernia after Total Gastrectomy

Abstract

Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

Hand-assisted laparoscopic surgery for an esophageal hiatal hernia with incarcerated transverse colon presenting after laparoscopic gastrectomy: a case report

“…In addition, three of four patients who underwent resection of the diaphragmatic crus did not undergo crus repair. Tashiro et al proposed that EHH could be caused by negative intrathoracic pressure, resection of the diaphragmatic crus, low BMI, and liver cirrhosis [ 8 ]. Ito et al suggested that crus incision without repair is associated with EHH after laparoscopic total gastrectomy [ 3 ].…”

Diaphragmatic Hernia After Totally Laparoscopic Total Gastrectomy for Gastric Cancer

“…It has been reported that LG could increase the risk of IH owing to less adhesion after surgery, compared with OG. 20 Especially, total gastrectomy with reconstruction using a long RY limb leads to dramatic weight loss postoperatively, and can result in a higher risk of IH after surgery. 21 IH after a laparoscopic RY limb procedure, such as transmesenteric and the Petersen hernia, are common postoperative complications because of the iatrogenically created structures.…”

Incarcerated Hiatal Hernia with Perforation after Laparoscopic Total Gastrectomy with Roux-en-Y Reconstruction: a Case Report

“…In a Japanese study, of 8,938 patients with gastrectomy for gastric cancer, only 13 were diagnosed as having an internal hernia (0.19%) and only 1 was considered as having a hiatal hernia (0.01%) [2]. The proposed causes of hiatal hernia were negative intrathoracic pressure, resection of the diaphragmatic crus, and liver cirrhosis, which is because the esophageal hiatus, is commonly covered by the left lateral segment of the liver [12]. The cause of iatrogenic hiatal hernia is most likely blunt dissection of the hiatus during operation, which enlarges the hiatus[131415].…”