Laparoscopic repair of hiatal hernia after minimally invasive esophagectomy

Minimally invasive esophagectomy for cancer decreases respiratory postoperative complications but seems to be associated with higher occurrence of hiatal hernia (HH). This study describes the incidence of this complication and the results of surgical repair.

Among 390 patients with esophageal cancer treated by esophagectomies with laparoscopic gastric dissection from 2000 to 2013, 32 (8.2%) patients developed HH. Demographics, diagnostic, surgical management and outcomes data were collected retrospectively.

There were 25 men and 7 women with a median age of 60 years (39-78). The median time between esophagectomy and diagnosis of HH was 10 months (3 days-96 months). The most frequent symptoms at the time of diagnosis were pain (32%), dyspnea (21%) and vomiting (10%), while HH was asymptomatic in 10 patients. HH was located in the left chest in 97% of patients and involved either the transverse colon (91%), or omentum (25%) or the small bowel (12%). The operation included the reintegration of the viscera associated with the closure of the pillars (100%) and the establishment of a mesh (71%). The operation was carried out by laparoscopy in 19 (59%) patients and was conducted in emergency in 6 (19%) patients. No patient died, and the overall morbidity was 25%. After a median follow-up of 40 months (range 1-55), five patients died due to oncologic evolution and six (19%) patients had recurrence of HH who required a second operation.

HH is a common complication after laparoscopic-assisted esophagectomy. Despite the use of mesh, postoperative morbidity and recurrence incidence remain high.