Abstract
Background
To evaluate the incidence, treatment and postoperative outcomes of an acute hiatal hernia (HH) after totally minimally invasive esophagectomy (tMIE) for oesophageal cancer.
Methods
The incidence and treatment of acute HH were analysed from our prospective database including all patients that were surgically treated for oesophageal cancer in the period between January 2011 and December 2018.
Results
Within the study period, the database contained 307 patients that underwent minimally invasive oesophagectomy. Patients’ characteristics were in line with the literature of Western data. The incidence of acute HH was 2.6% (N = 8). All patients presented with gastro-intestinal obstruction symptoms, that required acute operation, repositioning of the intrathoracic organs in combination with a crural repair. Mesh reinforcement was used in 38% (N = 3). In two patients, the intestines were partially resected due to ischemia. Postoperative complications, as atrial fibrillation, respiratory failure and anastomotic leakage, were seen in 63% (N = 5). Recurrence-rate was 38% (N = 3).
Conclusions
This present study demonstrates that an acute HH after tMIE is a serious complication with an incidence of 2.6%. When symptomatic and acute, HH requires surgical intervention and has high postoperative morbidity and recurrence-rate. Therefore, this requires treatment in a centre specialised in oesophageal surgery.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11605-020-04745-w/MediaObjects/11605_2020_4745_Fig1_HTML.jpg)
Similar content being viewed by others
References
Biere SS, van Berge Henegouwen MI, Maas KW, Bovina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887-1892.
Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS. Outcomes after minimally invasive esophagectomy: Review of over 1000 patients. Ann Surg 2012;256:95-103.
Oor JE, Wiezer MJ, Hazebroek EJ. Hiatal hernia after open versus minimally invasive esophagectomy: A systematic review and meta-analysis. Ann Surg Oncol. 2016;23:2690-2698.
Messenger DE, Higgs SM, Dwerryhouse SJ, Hewin DF, Vipond MN, Barr H, Wadley MS. Symptomatic diaphragmatic herniation following open and minimally invasive oesophagectomy: Experience from a UK specialist unit. Surg Endosc. 2015;29:417-424.
Matthews J, Bhanderi S, Mitchell H, Whiting J, Vohra R, Hodson J, Griffiths E. Diaphragmatic herniation following esophagogastric resectional surgery: An increasing problem with minimally invasive techniques? : Post-operative diaphragmatic hernias. Surg Endosc. 2016;30:5419-5427.
Benjamin G, Ashfaq A, Chang YH, Harold K, Jaroszewski D. Diaphragmatic hernia post-minimally invasive esophagectomy: A discussion and review of literature. Hernia. 2015;19:635-643.
Andreou A, Pesthy S, Struecker B, Dadras M, Raakow J, Knitter S, Duwe G, Sauer IM, Beierle AS, Denecke C, Chopra S, Pratschke J, Biebl M. Incidence and risk factors of symptomatic hiatal hernia following resection for gastric and esophageal cancer. Anticancer Res. 2017;37:7031-7036.
Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. 7th ed. Oxford: Balckwell Publishing; 2010.
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wjnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HB, van der Gaast A, CROSS Group Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074-2084.
Brenkman HJ, Parry K, Noble F, van Hillegersberg R, Sharland D, Goense L, Kelly J, Byrne JP, Underwood TJ, Ruurda JP. Hiatal hernia after esophagectomy for cancer. Ann Thorac Surg. 2017;103:1055-1062.
Crespin OM, Farjah F, Cuevas C, Armstrong A, Kim BT, Martin AV, Pellegrini CA, Oelschlager BK. Hiatal herniation after transhiatal esophagectomy: An underreported complication. J Gastrointest Surg. 2016;20:231-236.
Gooszen JAH, Slaman AE, van Dieren S, Gisbertz SS, van Berge Henegouwen MI. Incidence and treatment of symptomatic diaphragmatic hernia after esophagectomy for cancer. Ann Thorac Surg. 2018;106:199-206.
Watson DI, Thompson SK, Devitt PG, Aly A, Irvine T, Woods SD, Gan S, Game PA, Jamieson GG. Five year follow-up of a randomized controlled trial of laparoscopic repair of very large hiatus hernia with sutures versus absorbable versus nonabsorbable mesh. Ann Surg. 2019.
Kent MS, Luketich JD, Tsai W, Churilla P, Federle M, Landreneau R, Alvelo-Rivera M, Schuchert M. Revisional surgery after esophagectomy: An analysis of 43 patients. Ann Thorac Surg. 2008;86:975-83; discussion 967-74.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lubbers, M., Kouwenhoven, E.A., Smit, J.K. et al. Hiatal Hernia with Acute Obstructive Symptoms After Minimally Invasive Oesophagectomy. J Gastrointest Surg 25, 603–608 (2021). https://doi.org/10.1007/s11605-020-04745-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-020-04745-w