Post-esophagectomy hiatal hernias: a systematic review and meta-analysis

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Statistics

Background:

• Post-esophagectomy hiatal hernia (PEHH) is a rare but serious complication.
• Minimally invasive esophagectomy (MIE) approaches may increase PEHH risk.
• Understanding PEHH incidence and risk factors is crucial for patient management.

Purpose of the Study:

• To systematically review and meta-analyze the incidence, risk factors, diagnostics, and treatments for PEHH.
• To identify factors associated with PEHH development after esophagectomy.
• To evaluate outcomes of surgical repair for PEHH.

Main Methods:

• Systematic literature search of MEDLINE, Scopus, and Cochrane databases (PRISMA guidelines).
• Meta-analysis of 34 studies including 837 PEHH cases to determine pooled odds ratios (ORs).
• Assessment of risk factors including MIE, obesity, and neoadjuvant chemoradiotherapy.

Main Results:

• Overall PEHH incidence was 4.1%.
• MIE (OR: 5.70) and neoadjuvant chemoradiotherapy (OR: 3.53) were associated with increased PEHH risk.
• Obesity (BMI > 25 kg/m²) significantly reduced PEHH rates (OR: 0.84).
• Minimally invasive repair was used in 50.4% of cases, with 31.7% morbidity and 2.1% mortality.

Conclusions:

• PEHH incidence is rising, with MIE and neoadjuvant therapy as significant risk factors.
• Surgical repair is standard for symptomatic PEHH.
• An individualized approach is recommended for asymptomatic PEHH, considering cancer prognosis.