[Hiatal hernia after esophagectomy]

To analyze the causes and surgical treatment of hiatal hernia after esophagectomy, technical features of surgery and methods of prevention.

We retrospectively analyzed the incidence of postoperative hiatal hernias after esophagectomy in patients with esophageal cancer between 2018 and 2023. Structure of hernias, surgical options and postoperative results were assessed.

We analyzed 161 patients after Ivor Lewis (n=101) and McKeown (n=60) esophagectomies (open surge surgeries - 43.5%, thoraco- and laparoscopic procedures - 23%, hybrid procedures - 33.5%). The incidence of postoperative hiatal hernia was 3.7%. Hernia occurred within 1-15 months. There were 5 men and 1 woman (mean age 65 years). In all cases, partial or complete dissection of the left diaphragmatic crura was performed. The incidence of hernia after minimally invasive surgery was 4.4%, after open surgery - 2.9%. Two (33.3%) patients underwent urgent surgery for ileus within 2 months after primary esophageal surgery. Three (50%) patients underwent elective surgery. One (16.6%) patient is currently followed-up. The complication was asymptomatic in 2 (33.3%) patients. One (16.6%) patient died after emergency surgery in a COVID hospital due to strangulated hernia and progressive respiratory failure. Mean follow-up period was 16 months. No recurrent hernias were diagnosed.

Hiatal hernias occur 2 times more often after minimally invasive esophagectomies. Active surgical strategy is necessary for symptomatic hernias due to high risk of strangulation and emergency interventions. The incidence of this complication is lower without wide diaphragmotomy, transection of the left diaphragmatic crus and high abdominal pressure during laparoscopic stage.