title: Revisional surgery after esophagectomy: an analysis of 43 patients.
abstract: BACKGROUND
  Reflux and postprandial fullness are common after esophagectomy. On occasion, these symptoms have an anatomic basis that requires operative correction. Two such conditions are the following: (1) a diaphragmatic hernia in which bowel herniates into the chest; and (2) a redundant conduit that impairs gastric emptying. The recognition of these conditions and the results of operative correction are the subject of this analysis.
  
  
  METHODS
  A retrospective review from 1995 to 2007 identified patients who developed either a diaphragmatic hernia or a redundant gastric conduit after esophagectomy. The presenting symptoms, operative approach, and outcomes after surgery were recorded.
  
  
  RESULTS
  Forty-three patients (representing 4% of the esophagectomy volume in this time period) were identified with a diaphragmatic hernia (n = 21), redundant gastric conduit (n = 19), or both (n = 3). Mean time from esophagectomy to diagnosis was 32 months for diaphragmatic hernia and 18 months for redundant conduit. The majority of hernias occurred to the left of the gastric conduit. A mechanical obstruction to gastric emptying was noted in 54% of patients with a redundant conduit. Forty patients underwent revisional surgery (minimally invasive: 35; open: 5). The recurrence rate after repair of a diaphragmatic hernia was 29%. Symptoms improved in 85% of patients after revision of a redundant conduit.
  
  
  CONCLUSIONS
  A diaphragmatic hernia or redundant conduit may occur years after esophagectomy. Hernias almost always occur adjacent to the greater curve of the stomach. The development of a redundant conduit may be associated with a functional outflow obstruction. Surgical correction of these conditions can alleviate symptoms in the majority of patients.
authors: Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA.
authors: Michael S
authors: MS
authors: Kent
authors: James D
authors: JD
authors: Luketich
authors: Wilson
authors: W
authors: Tsai
authors: Patricia
authors: P
authors: Churilla
authors: Michael
authors: M
authors: Federle
authors: Rodney
authors: R
authors: Landreneau
authors: Miguel
authors: M
authors: Alvelo-Rivera
authors: Matthew
authors: M
authors: Schuchert
mesh_terms: D016629:Esophagectomy / Q000379:methods; D005746:Gastric Emptying; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome