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The incidence of hiatal hernia after minimally invasive esophagectomy
Nathan W Bronson1, Renato A Luna, John G Hunter
1Department of Surgery, Oregon Health & Science University, Mail Code L223A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA, bronsonn@ohsu.edu.
Introduction:
Minimally invasive esophagectomy (MIE) has evolved as a means to minimize the morbidity of an operation which is traditionally associated with a significant risk. However, this approach may have its own unique postoperative complications. In this study, we describe the incidence and outcomes of hiatal hernia in a cohort of MIE patients.
Methods:
Clinical follow-up data on 114 patients who had undergone minimally invasive esophagectomy between 2003 and 2011 were retrospectively reviewed. Clinical presentation and computed tomography (CT) scans of the chest and abdomen were used to establish the diagnosis of hiatal herniation after minimally invasive esophagectomy. Age, gender, presenting complaint, comorbid conditions, clinical tumor stage, surgical specimen size, length and cost of hospital admissions, operation performed for hiatal herniation, and mortality were all recorded for analysis.
Results:
Nine (8%) of the 114 patients who underwent MIE had postoperative hiatal herniation. Five of these patients were asymptomatic. All patients except two who presented emergently were repaired laparoscopically on an elective basis. The average length of stay after hiatal hernia repair was 5.5 days (range 2-12) at an average charge of $40,785 (range $25,264-$83,953). At follow-up, one patient complained of symptoms associated with reflux.
Conclusion:
Hiatal herniation is not a rare event after MIE. It is also associated with significant health-care cost and may be lethal. Most occurrences appear to be asymptomatic and, if detected, can be repaired with good resolution of symptoms, minimal associated morbidity, and no mortality.
Insights
Postoperative hiatal hernia occurs in 8% of patients after minimally invasive esophagectomy (MIE). While often asymptomatic, hiatal hernias can lead to significant costs and potential mortality, though repair offers good outcomes.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Surgical Complications
Background:
- Minimally invasive esophagectomy (MIE) aims to reduce surgical risks.
- MIE may present unique postoperative complications, such as hiatal hernias.
Purpose of the Study:
- To describe the incidence and outcomes of hiatal hernias following MIE.
Main Methods:
- Retrospective review of 114 MIE patients (2003-2011).
- Diagnosis via clinical presentation and CT scans.
- Analysis of patient demographics, clinical factors, and outcomes.
Main Results:
- 8% (9/114) of MIE patients developed hiatal hernias.
- 5 were asymptomatic; most were repaired laparoscopically.
- Hiatal hernia repair averaged 5.5 days stay and $40,785 cost.
Conclusions:
- Hiatal hernia is a notable complication after MIE.
- It carries significant healthcare costs and potential mortality.
- Symptomatic hernias can be successfully repaired with minimal morbidity and no mortality.
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