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Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature

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Abstract

Background

Diaphragmatic hernia (DH) after esophagectomy is a known complication which can occur and the incidence may be higher after minimally invasive esophagectomy (MIE). A review of our cases involving post-MIE diaphragmatic hernias and the published literature is presented.

Methods

A retrospective review of patients who underwent MIE from November 2006 to January 2013 was performed. An Embase and Pub Med literature search on diaphragmatic hernia post-esophagectomy was conducted from 1990 to 2013 and reviewed.

Results

In total, 120 consecutive patients underwent MIE at our institution. Neoadjuvant chemoradiotherapy had been performed in 71.4 % of patients. The mean age was 65 ± 22 years and 85 % were male. Seven patients (5.8 %) were diagnosed with DH by radiographic imaging with 5 (71.4 %) requiring surgical intervention. Diagnosis was made at a median time of 3.4 months (range 1–45 months) after MIE. One patient recurred after repair and underwent a second repair. There were no related mortalities. In literature review, 11 publications reporting DH were reviewed documenting a total of 4669 esophagectomies, with 756 MIE. The incidence of DH observed was 121 (2.6 %) in all patients and 34 (4.5 %) in MIE. Two studies comparing open versus MIE also reported a higher incidence of DH in MIE.

Conclusions

Post-esophagectomy diaphragmatic hernia can occur and may be underreported. Minimally invasive esophagectomy appears to have a higher incidence of postoperative herniation when compared to traditional, open esophagectomy.

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Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ, 85054, USA

    G. Benjamin, A. Ashfaq & D. Jaroszewski

  2. Division of Health Sciences Research, Mayo Clinic, Phoenix, AZ, USA

    Y.-H. Chang

  3. Division of Minimally Invasive Surgery, Mayo Clinic, Phoenix, AZ, USA

    K. Harold

Authors
  1. G. Benjamin
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  2. A. Ashfaq
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  3. Y.-H. Chang
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  4. K. Harold
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  5. D. Jaroszewski
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Corresponding author

Correspondence to D. Jaroszewski.

Additional information

This study was an oral presentation at the 40th Annual Meeting of the Western Thoracic Surgical Meeting, June 2014, Dana Point, CA.

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Benjamin, G., Ashfaq, A., Chang, YH. et al. Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature. Hernia 19, 635–643 (2015). https://doi.org/10.1007/s10029-015-1363-8

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  • DOI: https://doi.org/10.1007/s10029-015-1363-8

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