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Laparoscopic Repair of Acute Post-Esophagectomy Diaphragmatic Herniation Following Minimal Access Esophagectomy

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

This study’s objective was to assess the presentation, incidence, operative approach, and outcomes of acute symptomatic post-esophagectomy diaphragmatic hernia (PEDH), following minimal access esophagectomy (MAE) for esophageal and gastro-esophageal junctional cancer. Between January 2010 and December 2020, all consecutive patients undergoing esophagectomy were retrospectively analyzed. Acute symptomatic PEDH occurred in 4 patients out of 680 consecutive patients undergoing esophagectomy (0.58%) and 636 MAE (0.63%). All patients were men, with a median age of 56.5 years, and underwent minimal access transhiatal resection. The presentation was varied; 2 had restlessness, agitation, and tachycardia; one acute respiratory distress; and the last was asymptomatic but had reduced air entry over left hemithorax with unexplained hypoxia. All had transverse colon herniation into the left hemithorax. Herniated viscera were reduced with closure of hiatal defect, 3 underwent laparoscopic repair, and one needed laparotomy. Meshplasty or bowel resection was not required. The median hospital stay was 9 days with no perioperative mortality. The major complications (Clavien-Dindo grade ≥ IIIa) occurred in 2 patients. One patient was lost to follow-up, 2 died of disease after a year and 15 months post-procedure, and one is doing well at 10 months without any relapse of hernia. Acute symptomatic PEDH is a rare complication after transhiatal esophagectomy and mainly occurs in the left hemithorax. The incidence appears to be less than 1% after MAE. Laparoscopic repair is feasible in most cases. We recommend routine assessment of hiatus and tightening of hiatus to snuggly accommodate the gastric conduit.

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Data Availability

The data that support the findings of this study are available on suitable request from the corresponding author.

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Authors and Affiliations

  1. Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India

    Subramanyeshwar Rao Thammineedi, KVVN Raju, Sujit Chyau Patnaik, Ajesh Raj Saksena, R. Rajagopalan Iyer & Syed Nusrath

  2. Department of Radiology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India

    Rashmi Sudhir

  3. Department of Anaesthesiology & Surgical Critical Care, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India

    Basanth Kumar Rayani

  4. Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA

    Lynnette M. Smith

  5. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA

    Chandrakanth Are

Authors
  1. Subramanyeshwar Rao Thammineedi
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  2. KVVN Raju
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  3. Sujit Chyau Patnaik
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  4. Ajesh Raj Saksena
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  6. Rashmi Sudhir
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  7. Basanth Kumar Rayani
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  8. Lynnette M. Smith
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  9. Chandrakanth Are
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  10. Syed Nusrath
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Contributions

Subramanyeshwar Rao, KVVN Raju, and Sujith Patnaik perceived the idea of study and helped in analyzing the data. Syed Nusrath collected data, analyzed, and wrote the manuscript. Literature review was done by all authors. All authors read and critically analyzed and approved the final version of the manuscript, and each one believes the work is a sincere and honest effort and takes the responsibility and credibility of the work. All authors warrant that the article is their original work, has not received prior publication, and is not under consideration for publication elsewhere.

Corresponding author

Correspondence to Syed Nusrath.

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The Institutional Review Board (IRB) approved this retrospective study and granted a waiver for individual consent as patient anonymity was not violated.

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The authors declare no competing interests.

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Thammineedi, S.R., Raju, K., Patnaik, S.C. et al. Laparoscopic Repair of Acute Post-Esophagectomy Diaphragmatic Herniation Following Minimal Access Esophagectomy. Indian J Surg Oncol 12, 729–736 (2021). https://doi.org/10.1007/s13193-021-01415-4

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  • DOI: https://doi.org/10.1007/s13193-021-01415-4

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