Hiatal Hernia with Acute Obstructive Symptoms After Minimally Invasive Oesophagectomy

Lubbers, Merel; Kouwenhoven, Ewout A.; Smit, Jw; Det, Marc J. van

doi:10.1007/s11605-020-04745-w

Cited by 6 publications

(13 citation statements)

References 12 publications

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“…Inadequate calibration of the hiatal ori ce and the absence of peritoneal adhesions following minimally invasive surgery predisposes to hernia complications in the postoperative period that may require emergency surgery for intestinal obstruction. The recommendation of several authors is that the repair to be performed if possible in a center specializing in esophageal surgery [35].…”

Section: Discussionmentioning

confidence: 99%

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Achim

Constantin

Mossen

et al. 2022

Preprint

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Introduction: Minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer over the past three decades. By introducing minimally invasive techniques, esophageal oncological surgery has advanced in terms of safety, radicality, functional preservation and quality of life post-esophagectomy of the patients. Material and Method: We present the experience of the Center of Excellence in Esophageal Surgery at Sf. Maria Clinical Hospital regarding total (MIE) through total 3D HD thoraco-laparoscopic modified McKeown triple approach. In between January 2015 - December 2021, 24 patients (M) were treated for thoracic esophageal cancer. The average age of patients was 57 years. Most of the esophageal tumors were midthoracic (62.5%), 83.3% were squamous carcinomas and half were moderately differentiated. Most of the esophageal tumors were locally advanced tumors (cT3N1 – 58.3%), 18 patients were staged III. 70.8% of patients received neoadjuvant chemo radiotherapy. Results: Thoracoscopic esophageal mobilizations were successful in all 24 patients, no conversion to thoracotomy. Laparoscopic gastric mobilizations were successful in all 24 patients, conversion to open technique was performed in 7 patients for creation extracoporeally of the gastric conduit through an epigastric minilaparotomy. The esophageal substitute was represented by the gastric conduit. The intraoperative blood loss was minimal. The average duration of surgical interventions was 360 minutes. All the surgical interventions were considered with curative intention (R0). The rate of intraoperative complications was 20.8%. The rate of early postoperative complications was 66%. Distribution of postoperative complications according to the Clavien-Dindo Classification (0-33.3%, 1-16.6%, 2-4.1%, 3a-12.5%, 3b-8.3%, 4a-0%, 4b-8.3%, 5-16.6%) highlighted a rate of 33.3% of major complications. The advantages of MIE observed in the studied group in the postoperative period were: reduced postoperative pain, improved comfort and early mobilization of the patients. Conclusions: The early outcomes of using the minimally invasive approach in the treatment of esophageal cancer in our clinic include the reduction of perioperative morbidity, the duration of hospitalization and a faster recovery.

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Section: Discussionmentioning

confidence: 99%

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Achim

Constantin

Mossen

et al. 2022

Preprint

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“…Approximately one-third of the affected patients develop post-esophagectomy HH early after index surgery, i.e. during the first 90 postoperative days due to lack of adhesions holding abdominal viscera in place [ 7 , 8 , 11 , 19 , 20 , 28 ]. These patients suffered more frequently from severe, acute respiratory and cardiac symptoms compared with patients, who developed HH in the long-run after index surgery [ 7 , 11 , 14 , 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The latter reported high rates for emergency post-esophagectomy HH repair of being 76% during the first 90 days and 41% beyond the first year after esophagectomy [ 7 ]. Therefore, the indication for surgical correction of trans-hiatal hernia after esophago-gastric surgery in moderate to severe symptomatic patients remains undoubtedly, whereas, whether asymptomatic to mild symptomatic patients should undergo either elective hernia repair or clinical observation with a “wait-and-see” strategy is controversially discussed in the current literature (literature review in Table 5 ) [ 10 , 14 , 17 , 20 ]. In the present study two of the patients, who underwent hernia repair, were asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…By that way, no predictors are known for an unfavorable outcome of conservative “wait-and-see” strategies, thus a great proportion of patients require emergency surgery although an initially intended “wait-and-see” concept [ 14 , 28 , 30 , 39 ]. Thereby, it is known that not only morbidity rates of the patients (up to 60%) with consecutively longer hospital stays but also mortality rates (up to 20%) are dramatically increased after hernia repair in the emergency situation [ 11 , 14 , 15 , 20 , 28 , 29 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…If tension is too strong for primary suturing, closure of the hiatal defect can be achieved by mesh as an inlay patch anteriorly from the conduit to the diaphragm with no approximation of the crural muscles [ 15 , 23 , 32 , 40 ]. Nevertheless, most articles in the current literature report a mixture of these techniques for hernia repair resulting in high recurrence rates, up to 38%, which, however, might be independently from mesh buttressing of suture cruroplasty [ 17 , 19 , 20 , 28 , 42 ]. Thereby care has to be taken on the blood supply of the jejunal limb or the gastric conduit from the right gastroepiploic artery after gastrectomy or esophagectomy, respectively, and not to obstruct the passage, which both can increase the risk for conduit necrosis and anastomotic leakages especially in cases of hiatal hernia repair in the early phase after gastrectomy or esophagectomy [ 9 – 11 , 13 , 16 – 21 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

Oppelt

Askevold

Hörbelt

et al. 2021

Hernia

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Purpose Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. Methods Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. Results Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. Conclusion Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.

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

Bona

Lombardo

Matsushima

et al. 2021

Langenbecks Arch Surg

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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.

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Hiatal Hernia with Acute Obstructive Symptoms After Minimally Invasive Oesophagectomy

Cited by 6 publications

References 12 publications

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

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

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