Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

Abstract

Introduction The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer. Materials and methods Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted. Results Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0–22.0%), 1.4% (95% CI = 0.8–2.2%), 35% (95% CI = 20.0–54.0%), and 5.0% (95% CI = 3.0–8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0–21.6%). Conclusions Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.

Post-Esophagectomy Hiatal Hernia: A Case Series

“…This meta-analysis also included 99 patients with post-esophagectomy hiatal hernia who were asymptomatic, of whom 17 were electively repaired [3]. Some studies have reported a higher incidence of hiatal hernia in minimally invasive esophagectomy as compared to open surgery [1,4]. Kent et al in their study of 1075 esophagectomies had an incidence of 0.8 % in open cases vs. 2.8% in minimally invasive cases with an overall incidence of 1.86% [5].…”

“…The incidence of hiatal hernia post-esophagectomy is variable and ranges from 0.4% to 15% [ 1 ]. A meta-analysis by Bona et al showed the post-esophagogastric surgery prevalence of hiatal hernia to be 3.18%, with 2.01% requiring surgery [ 1 ]. In our retrospective analysis of past 4 years, we have also found the hiatal hernia rates to be around 3%.…”

“…Some studies have reported a higher incidence of hiatal hernia in minimally invasive esophagectomy as compared to open surgery [ 1 , 4 ]. Kent et al in their study of 1075 esophagectomies had an incidence of 0.8 % in open cases vs. 2.8% in minimally invasive cases with an overall incidence of 1.86% [ 5 ].…”

“…Kent et al in their study of 1075 esophagectomies had an incidence of 0.8 % in open cases vs. 2.8% in minimally invasive cases with an overall incidence of 1.86% [ 5 ]. Bona et al in their study of 404 esophagectomies also showed a higher incidence of hiatal hernia in minimally invasive esophagectomy ranging upto 22.1% as compared to upto 12.3% after open procedures [ 1 ].…”

“…It can present incidentally, symptomatically, or as an emergency requiring urgent surgical intervention. The post-esophagogastric surgery hiatal hernia prevalence is 3.18%, and 2.01% of patients require surgical treatment [ 1 ]. Emergency repair is associated with higher morbidity (21% vs. 5.2%), higher mortality (5.5% vs. 0.65%), and longer hospital stay (8 days vs. 3 days) as compared to elective repair [ 2 ].…”