Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature.
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.
Division of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ, 85054, USA.
G
G
Benjamin
A
A
Ashfaq
Y-H
YH
Chang
K
K
Harold
D
D
Jaroszewski
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects