title: Treatment of Diaphragmatic Hernia Occurring After Transhiatal Esophagectomy.
abstract: BACKGROUND
  Postesophagectomy diaphragmatic hernia (DH) is an uncommon problem but an important one to recognize and treat because of the risk of significant complications such as incarceration and strangulation. Diaphragmatic hernia appears to occur more frequently following transhiatal esophagectomy (THE) than after transthoracic procedures, likely because of the enlargement of the diaphragmatic hiatus required to perform THE.
  
  
  METHODS
  After 199 consecutive esophagectomies were performed at Rutgers Robert Wood Johnson University Hospital between January 2000 and June 2013, ten patients were identified with DH; all underwent diaphragmatic hernia repair (DHR). All patients who underwent esophagectomy during this time period were cataloged in a prospectively maintained database that was then retrospectively reviewed. All DH were repaired using a novel biologic plug mesh technique.
  
  
  RESULTS
  Ten esophagectomy patients developed DH; nine post-THE and one post-McKeown esophagectomy. One patient was excluded from analysis because of atypical presentation. Demographic data were similar between esophagectomy patients who developed DH and those who did not. Administration of neoadjuvant chemoradiation correlated with development of DH, but did not reach statistical significance. Complications directly related to DHR were few and mostly infectious, including empyema and pneumonia, and were more likely to occur in those who presented with acute obstruction. One patient presented with dysphagia post repair.
  
  
  CONCLUSIONS
  Diaphragmatic hernia development post esophagectomy is an uncommon complication, but can have devastating results when there is bowel compromise. Repair by plugging the diaphragmatic hiatus with a biologic mesh is a safe and effective method for closing the defect and results in few complications.
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA.
authors.forename: Sumana
authors.initials: S
authors.lastname: Narayanan
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA.
authors.forename: Renee L
authors.initials: RL
authors.lastname: Sanders
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA.
authors.forename: Georg
authors.initials: G
authors.lastname: Herlitz
authors.affiliation: The Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.|Department of Surgery, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA.
authors.forename: John
authors.initials: J
authors.lastname: Langenfeld
authors.affiliation: The Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. augustda@cinj.rutgers.edu.|Department of Surgery, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA. augustda@cinj.rutgers.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: August
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006548:Hernia, Diaphragmatic / Q000209:etiology* / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013526:Surgical Mesh