title: Hiatal Herniation After Transhiatal Esophagectomy: an Underreported Complication.
abstract: BACKGROUND
  The incidence and presentation of hiatal hernias after esophagectomy (HHAE) are not well characterized, and may be changing with increased survival from esophageal cancer. The aims of this study were to define the incidence and presentation of HHAE in our population of patients undergoing transhiatal esophagectomy (THE), as it may have implications for management.
  
  
  METHODS
  A retrospective cohort study (2004-2013) was performed of esophageal cancer patients who underwent THE. To determine the presence or absence of HHAE independent of the original radiology report, a radiologist sub-specializing in body imaging independently reviewed post-operative computed tomography images. A time-to-event competing risk analysis was performed to estimate the cumulative incidence of HHAE.
  
  
  RESULTS
  Among 192 patients, the two-year cumulative incidence of HHAE was 14 % (95 % confidence interval 7.5-21 %). Of the 22 patients determined to have HHAE by independent expert radiologist review, only 11 (50 %) were identified by the original interpreting radiologist. Seven patients were symptomatic, and each underwent hiatal hernia repair (4 via laparotomy, 3 via laparoscopy).
  
  
  CONCLUSIONS
  HHAE is not rare and is often unrecognized. As more patients with esophageal cancer survive, the number of patients becoming symptomatic and requiring repair may also rise. Therefore, it is important to consider this diagnosis when following patients long-term after esophagectomy.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA. crespinmax@gmail.com.
authors.forename: Oscar M
authors.identifier: http://orcid.org/0000-0003-1215-4843
authors.initials: OM
authors.lastname: Crespin
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.|Surgical Outcomes Research Center, University of Washington, Seattle, WA, USA.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Department of Radiology Seattle, University of Washington, Seattle, WA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cuevas
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Analisa
authors.initials: A
authors.lastname: Armstrong
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Ana V
authors.initials: AV
authors.lastname: Martin
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pellegrini
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Brant K
authors.initials: BK
authors.lastname: Oelschlager
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed
keywords: Esophagectomy; Hiatal hernia