title: Crus incision without repair is a risk factor for esophageal hiatal hernia after laparoscopic total gastrectomy: a retrospective cohort study.
abstract: Although postoperative esophageal hiatal hernia (EHH) is primarily considered a post-operative complication of esophagectomy, it is also a rare post-operative complication of laparoscopic total gastrectomy (LTG), with a reported incidence rate of 0.5 %. The purpose of this study is to analyze the incidence, clinical features, and prevention of EHH following LTG for gastric cancer.
  
  
  
  Between October 2008 and July 2014, 78 patients who underwent LTG for gastric cancer in our hospital were analyzed. We compared the crus incision group (in which the left crus of the diaphragm was incised without suture repair) with the crus conserving or repair group (in which the crus was preserved or the crus was incised and underwent suture repair). The primary endpoint was incidence of postoperative EHH.
  
  
  
  Of the 78 patients, 7 (9.0 %) developed postoperative EHH. Three of seven patients (42.9 %) were symptomatic and required an emergency operation for intestinal obstruction. Four of seven patients (57.1 %) were asymptomatic and did not require an operation. Incising the left crus of the diaphragm without suture repair during LTG was considered the only risk factor for postoperative EHH (0 of 29 for preserving the crus or incising and performing suture repair of the crus vs. 7 of 49 in crus incision without suture repair; p = 0.033).
  
  
  
  The present data suggest that incision of the crus without suture repair is associated with EHH after LTG. If crus incision is required, crus repair may be effective for the prevention of postoperative EHH.
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan. i_eisaku_ukasie@yahoo.co.jp.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ito
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ohdaira
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Nakashima
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Imakita
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsutsui
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006551:Hernia, Hiatal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013537:Sutures
keywords: Crus repair; Esophageal hiatal hernia; Laparoscopic total gastrectomy