Diaphragmatic Herniation after Transthoracic Esophagectomy for Esophageal Cancer

Abstract

Objectives: Diaphragmatic herniation (DH) after transthoracic esophagectomy for esophageal cancer is a rare postoperative complication. This complication sometimes occurs suddenly and leads to a severe post-operative course. However, the incidence of and risk factors for DH are not fully documented. Methods: In our institute, 340 patients with resectable esophageal cancer underwent right-sided transthoracic esophagectomy accompanied by laparoscopic or open gastric mobilization between April 2000 and January 2014. We retrospectively investigated the incidence of DH after surgery and risk factors for DH. Results: During this period, a total of 10 cases (2.9%, 10/340) of DH occurred. In all cases, DH originated from the hiatus and extended to the left thorax. Time interval from initial surgery to surgery for DH widely varied (1 day- 57 months). Eight patients presented with sudden abdominal pain, while two patients had asymptomatic. DH was diagnosed using chest X-ray and/or CT scan in all cases. The hernial contents consisted of transverse colon in 4 cases, both transverse colon and small intestine in 4 cases. An incision of the left pleura around the esophageal hiatus and the direct route between left thorax and abdominal cavity were observed in all cases. Univariate analysis revealed that the laparoscopic approach of the abdominal cavity at the initial surgery were significant risk factors for DH. Conclusion: DH after transthoracic esophagectomy is relatively a rare but certain incidence of complication. Intraoperative prevention and careful postoperative attention might be required for DH after laparoscopic esophageal surgery.