Incidence of diaphragmatic hernias following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy

Objectives To compare the incidence of post-operative hiatal herniation after open and minimally invasive Ivor Lewis McKeown esophagectomy for malignant disease. Methods All patients undergoing esophageal resection were entered into a prospectively maintained database. After Institutional Review Boa...

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Published in:	Hernia : the journal of hernias and abdominal wall surgery Vol. 16; no. 2; pp. 185 - 190
Main Authors:	Willer, B. L., Worrell, S. G., Fitzgibbons, R. J., Mittal, S. K.
Format:	Journal Article
Language:	English
Published:	Paris Springer-Verlag 01-04-2012 Springer Nature B.V
Subjects:	Abdominal Surgery Aged Esophagectomy - adverse effects Esophagectomy - methods Female Hernia, Hiatal - diagnostic imaging Hernia, Hiatal - epidemiology Humans Incidence Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgical Procedures Original Article Postoperative Complications - epidemiology Tomography, X-Ray Computed Hiatal hernia Minimally invasive esophagectomy Transthoracic esophagectomy
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Summary:	Objectives To compare the incidence of post-operative hiatal herniation after open and minimally invasive Ivor Lewis McKeown esophagectomy for malignant disease. Methods All patients undergoing esophageal resection were entered into a prospectively maintained database. After Institutional Review Board approval, the database was queried to identify patients who underwent minimally invasive (MIE) and open transthoracic (TTE) Ivor Lewis McKeown esophagectomy (transthoracic three-hole) with gastric pull-up for malignant disease. The cohorts were compared for the incidence of hiatal hernia on routine CT scan for cancer surveillance. Data up to 24 months post-operatively was included. Patients undergoing trans-hiatal or hybrid procedures as well as intra-thoracic anastomosis were excluded as were patients in whom jejunum or colon was used for reconstruction. Results Between 2003 and 2009, 19 MIEs and 20 open TTEs met the inclusion criteria. There was no significant difference in age, co-morbidity, pathology or perioperative morbidity and mortality between the two groups. During routine follow-up, para-gastric hiatal hernia was noted on CT scan in 5(26%) patients following MIE at a mean of 13.8 months postoperatively, with incidence ranging from 3 to 20 months postoperatively (19, 20, 18, 3, and 9 months, respectively). Hernia contents in these patients were omentum in one case and colon in the other four cases. None of the patients undergoing TTE were noted to have herniation ( P = 0.01). All hernias were asymptomatic; three were repaired electively. Conclusions There was a significantly higher incidence of para-gastric hiatal hernia after Ivor Lewis McKeown minimally invasive esophagectomy compared to similar open procedures. Additional precautions to prevent para-gastric hernia should be taken during laparoscopic resection.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1265-4906 1248-9204
DOI:	10.1007/s10029-011-0884-z