Symptomatic diaphragmatic herniation following open and minimally invasive oesophagectomy: experience from a UK specialist unit

Abstract

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.

Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?

“…Our results are similar to another UK series published recently [11]. Messenger et al reported a higher rate after hybrid esophagectomy (12 % 8/67) and full MIO (17 % 1/6); however, this was based on a smaller series than in our study.…”

“…PODH was defined as thoracic herniation of any abdominal organ or viscus other than a normally placed gastric pull-up or roux-en-y limb following esophagectomy or total gastrectomy, respectively [10,11].…”

Diaphragmatic hernia following oesophagectomy for oesophageal cancer - Are we too radical?

“… [10] , incidences of diaphragmatic hernia following open transhiatal or transthoracic oesophagectomies are reported to be the same [11] , [13] , whereas minimally invasive approaches appear to carry a higher risk compared to open procedures [14] , [15] . Reasons for this may be paucity of adhesions [16] , [17] , more extensive dissection promoted by the magnified laparoscopic vision [15] , distortion resulting from the abdominal insufflation [11] , or prolonged pneumoperitoneum [18] , [19] Further, rates are higher following neoadjuvant chemo-irradiation [20] , possibly due to more extensive peri hiatal dissection in patients with more advanced disease.…”

“…Herniation is more common into the left chest [10] , [14] , [15] , [20] . Reasons for this left-sided predominance could be related to the presence of the left and caudate lobes of the liver blocking the access to the right chest (21), to the adhesions induced by the gastric staple line [14] , [21] , to the smooth shape of the greater curvature that can allow abdominal contents to slide into the left chest [14] , [21] .…”

Emergency Laparoscopic Repair of Giant Left Diaphragmatic Hernia following Minimally Invasive Esophagectomy: Description of a Case and Review of the Literature

“…Postoperative diaphragmatic hernia (PDH) is a well-known complication of esophageal cancer surgery that can be associated with significant morbidity and mortality [ 1 – 6 ]. The risk of developing PDH after esophagectomy seems to be much higher when minimally invasive techniques are employed [ 2 – 5 , 7 ]. Several mechanisms and risk factors may be involved in the pathogenesis of PDH, and many measures have been suggested in order to minimize its occurrence, although little evidence is available on this regard [ 1 – 11 ].…”