title: The incidence of hiatal hernia after minimally invasive esophagectomy.
abstract: BACKGROUND
  Minimally invasive esophagectomy (MIE) has evolved as a means to minimize the morbidity of an operation which is traditionally associated with a significant risk. However, this approach may have its own unique postoperative complications. In this study, we describe the incidence and outcomes of hiatal hernia in a cohort of MIE patients.
  
  
  METHODS
  Clinical follow-up data on 114 patients who had undergone minimally invasive esophagectomy between 2003 and 2011 were retrospectively reviewed. Clinical presentation and computed tomography (CT) scans of the chest and abdomen were used to establish the diagnosis of hiatal herniation after minimally invasive esophagectomy. Age, gender, presenting complaint, comorbid conditions, clinical tumor stage, surgical specimen size, length and cost of hospital admissions, operation performed for hiatal herniation, and mortality were all recorded for analysis.
  
  
  RESULTS
  Nine (8%) of the 114 patients who underwent MIE had postoperative hiatal herniation. Five of these patients were asymptomatic. All patients except two who presented emergently were repaired laparoscopically on an elective basis. The average length of stay after hiatal hernia repair was 5.5 days (range 2-12) at an average charge of $40,785 (range $25,264-$83,953). At follow-up, one patient complained of symptoms associated with reflux.
  
  
  CONCLUSIONS
  Hiatal herniation is not a rare event after MIE. It is also associated with significant health-care cost and may be lethal. Most occurrences appear to be asymptomatic and, if detected, can be repaired with good resolution of symptoms, minimal associated morbidity, and no mortality.
authors.affiliation: Department of Surgery, Oregon Health & Science University, Mail Code L223A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA, bronsonn@ohsu.edu.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Bronson
authors.forename: Renato A
authors.initials: RA
authors.lastname: Luna
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
authors.forename: James P
authors.initials: JP
authors.lastname: Dolan
mesh_terms: D000328:Adult; D000368:Aged; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006551:Hernia, Hiatal / Q000191:economics / Q000209:etiology* / Q000601:surgery; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies