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Author Spotlight: Recent Advancements in Reoperative Foregut Surgery

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[Hiatal hernia after esophagectomy].

A B Ryabov¹, O V Pikin¹, V M Khomyakov¹

¹Herzen Moscow Oncology Research Institute, Moscow, Russia.

|November 25, 2024

Summary

Hiatal hernias are twice as common after minimally invasive esophagectomies. Prompt surgical intervention is crucial for symptomatic hernias to prevent life-threatening complications like strangulation.

Keywords:

diaphragm repair esophagectomy laparoscopic approach postoperative hiatal hernia

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Area of Science:

Gastroenterology and Surgical Oncology
Thoracic Surgery
Minimally Invasive Surgery

Context:

Esophagectomy for esophageal cancer can lead to postoperative complications.
Hiatal hernias represent a significant, though infrequent, complication following esophagectomy.
Understanding risk factors and management strategies is vital for patient outcomes.

Purpose:

To analyze the incidence, causes, and surgical treatment of hiatal hernias post-esophagectomy.
To evaluate the technical aspects of surgical repair and preventative measures.
To compare hernia rates between open and minimally invasive esophagectomy approaches.

Summary:

A retrospective analysis of 161 esophagectomy patients (2018-2023) revealed a 3.7% incidence of hiatal hernias.
Hernias were more frequent (4.4%) after minimally invasive procedures compared to open surgery (2.9%).
Surgical repair was required for symptomatic hernias, with one fatality due to strangulation and respiratory failure.

Impact:

Minimally invasive esophagectomy techniques may increase hiatal hernia risk.
Aggressive surgical management is recommended for symptomatic hiatal hernias.
Avoiding wide diaphragmotomy and excessive intra-abdominal pressure may reduce complication rates.