title: Laparoscopic repair of hiatal hernia after minimally invasive esophagectomy.
abstract: BACKGROUND
  Minimally invasive esophagectomy for cancer decreases respiratory postoperative complications but seems to be associated with higher occurrence of hiatal hernia (HH). This study describes the incidence of this complication and the results of surgical repair.
  
  
  METHODS
  Among 390 patients with esophageal cancer treated by esophagectomies with laparoscopic gastric dissection from 2000 to 2013, 32 (8.2%) patients developed HH. Demographics, diagnostic, surgical management and outcomes data were collected retrospectively.
  
  
  RESULTS
  There were 25 men and 7 women with a median age of 60 years (39-78). The median time between esophagectomy and diagnosis of HH was 10 months (3 days-96 months). The most frequent symptoms at the time of diagnosis were pain (32%), dyspnea (21%) and vomiting (10%), while HH was asymptomatic in 10 patients. HH was located in the left chest in 97% of patients and involved either the transverse colon (91%), or omentum (25%) or the small bowel (12%). The operation included the reintegration of the viscera associated with the closure of the pillars (100%) and the establishment of a mesh (71%). The operation was carried out by laparoscopy in 19 (59%) patients and was conducted in emergency in 6 (19%) patients. No patient died, and the overall morbidity was 25%. After a median follow-up of 40 months (range 1-55), five patients died due to oncologic evolution and six (19%) patients had recurrence of HH who required a second operation.
  
  
  CONCLUSIONS
  HH is a common complication after laparoscopic-assisted esophagectomy. Despite the use of mesh, postoperative morbidity and recurrence incidence remain high.
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France. bea310301@libero.it.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ulloa Severino
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France. david.fuks@imm.fr.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Christos
authors.initials: C
authors.lastname: Christidis
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Denet
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Perniceni
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hiatal hernia; Laparoscopic repair; Laparoscopic-assisted esophagectomy