Abstract
Background
The uptake of minimally invasive oesophagectomy (MIO) in the UK has increased dramatically in recent years. Post-oesophagectomy diaphragmatic hernias (PODHs) are rare, but may be influenced by the type of approach to resection. The aim of this study was to compare the incidence of symptomatic PODH following open and MIO in a UK specialist centre.
Methods
Consecutive patients undergoing oesophagectomy for malignant disease between 1996 and 2012 were included. A standardised, radical approach to the abdominal phase was employed, irrespective of the type of procedure undertaken. Patient demographics, details of surgery and post-operative complications were collected from patient records and a prospective database.
Results
A total of 273 oesophagectomies were performed (205 open; 68 MIO). There were 62 hybrid MIOs (laparoscopic abdomen and thoracotomy) and six total MIOs. Seven patients required conversion and were analysed as part of the open cohort. Nine patients (13.2 %) developed a PODH in the MIO cohort compared with two patients (1.0 %) in the open cohort, (p < 0.001). Five patients developed hernias in the early post-operative period (days 2–10): all following MIO. Both PODHs in the open cohort occurred following transhiatal oesophagectomy. All PODHs were symptomatic and required surgical repair. CT thorax confirmed the diagnosis in 10 patients. Seven hernias were repaired laparoscopically, including two cases in the early post-operative period. PODHs were repaired using the following techniques: suture (n = 6), mesh reinforcement (n = 4) and omentopexy to the anterior abdominal wall without hiatal closure (n = 1). There were two recurrences (18 %).
Conclusions
The incidence of symptomatic PODH may be higher following MIO compared to open surgery. The reasons for this are unclear and may not be completely explained by the reduction in adhesion formation. Strategies such as fixation of the conduit to the diaphragm and omentopexy to the abdominal wall may reduce the incidence of herniation.
Similar content being viewed by others
References
The Royal College of Surgeons of England (2013) National Oesohago-Gastric Cancer Audit 2013. An audit of the care received by people with oesophago-gastric cancer in England and Wales. http://www.rcseng.ac.uk/media/docs/press_releases/national-oesophago-gastric-cancer-audit-2013. Accessed 27 March 2014
Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H et al (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24:1621–1629
Biere S, van Berge Henegouwen M, Maas K, Bonavina L, Rosman C, Garcia J et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892
Fumagalli U, Rosati R, Caputo M, Bona S, Zago M, Lutmann F, Peracchia A (2006) Diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy. Dis Esophagus 19:40–43
Vallböhmer D, Hölscher AH, Herbold T, Gutschow C, Schröder W (2007) Diaphragmatic hernia after conventional or laparoscopic-assisted transthoracic esophagectomy. Ann Thorac Surg 84:1847–1853
Kent MS, Luketich JD, Tsai W, Churilla P, Federle M, Landreneau R, Alvelo-Rivera M, Schucher M (2008) Revisional surgery after esophagectomy: an analysis of 43 patients. Ann Thorac Surg 86:975–983
Sutherland J, Banerji N, Morphew J, Johnson E, Dunn D (2011) Postoperative incidence of incarcerated hiatal hernia and its prevention after robotic transhiatal esophagectomy. Surg Endosc 25:1526–1530
Willer BL, Worrell SG, Fitzgibbons RJ Jr, Mittal SK (2012) Incidence of diaphragmatic hernias following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy. Hernia 16:185–190
Ganeshan DM, Correa AM, Bhosale P, Vaporciyan AA, Rice D, Mehran RJ, Walsh GL, Iyer R, Roth JA, Swisher SG, Hofstetter WL (2013) Diaphragmatic hernia after esophagectomy in 440 patients with long-term follow-up. Ann Thorac Surg 96:1138–1145
Bronson NW, Luna RA, Hunter JG, Dolan JP (2014) The incidence of hiatal hernia after minimally invasive esophagectomy. J Gastrointest Surg. doi:10.1007/s11605-014-2481-9
Barbier PA, Luder PJ, Schupfer G, Becker CD, Wagner HE (1988) Quality of life and patterns of recurrence following transhiatal esophagectomy for cancer: results of a prospective follow-up of 50 patients. World J Surg 12:270–276
Katariya K, Harvey JC, Pina E, Beattie EJ (1994) Complications of transhiatal esophagectomy. J Surg Oncol 57:157–163
Heitmiller RF, Gillinov AM, Jones B (1997) Transhiatal herniation of colon after esophagectomy and gastric pull-up. Ann Thorac Surg 63:554–556
Orringer MB (1996) Transhiatal esophagectomy without thoracotomy. In: Orringer MB, Zuidema GD (eds) Shackelford’s surgery of the alimentary tract, vol 1, 4th edn. WB Saunders, Philadelphia, pp 414–445
Van Sandick JW, Knegjens JL, van Lanschot JJB, Obertop H (1999) Diaphragmatic herniation following oesophagectomy. Br J Surg 86:109–112
Franceschi A, Mariette C, Balon JM, Fabre S, Triboulet JP (2002) Hernie diaphragmatique après oesophagectomie: à propos de deux cas et revue de la literature. Ann Chir 127:62–64
Liu JF, Wang QZ, ** YM, Zhang YD (2008) Complications after esophagectomy for cancer: 53-year experience with 20,796 patients. World J Surg 32:395–400
Daiko H, Nishimura M, Hayashi R (2010) Diaphragmatic herniation after esophagectomy for carcinoma of the oesophagus: a report of two cases. Esophagus 7:169–172
Price TN, Allen MS, Nichols FC, Cassivi SD, Wigle DA, Shen KR, Deschamps C (2011) Hiatal hernia after esophagectomy: analysis of 2,182 esophagectomies from a single institution. Ann Thorac Surg 92:2041–2045
Nicholas R, Guarino S, Qureshi Y, Hughes F (2013) Diaphragmatic hernia following laparoscopically-assisted Ivor-Lewis oesophagectomy: experience from 206 consecutive oesophagectomies. Br J Surg 100(Suppl 8):5A
Frantzides CT, Madan AK, Carlson MA, Stavropoulus GP (2002) A prospective randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs. simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652
Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointer R (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140:40–48
Disclosures
David Messenger, Simon Higgs, Simon Dwerryhouse, David Hewin, Mark Vipond, Hugh Barr and Martin Wadley have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Messenger, D.E., Higgs, S.M., Dwerryhouse, S.J. et al. Symptomatic diaphragmatic herniation following open and minimally invasive oesophagectomy: experience from a UK specialist unit. Surg Endosc 29, 417–424 (2015). https://doi.org/10.1007/s00464-014-3689-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3689-1