Post-esophagectomy diaphragmatic hernia—a case series

Abstract

Herniation of abdominal viscera through the esophageal hiatus is a rare complication following surgery for esophageal malignancies. This complication sometimes occurs suddenly and leads to a severe postoperative course. We present three cases of post-esophagectomy diaphragmatic hernia operated for cancer of the lower esophagus. All patients underwent initial upper gastrointestinal (GI) endoscopy and biopsies for diagnosis. Staging was done by contrast computed tomography (CT) of the chest/abdomen/pelvis. Patients underwent neoadjuvant chemotherapy followed by surgery. No patients had previous hiatal hernias prior to surgery, and full crural sling dissections were carried out in all cases. The three cases vary in clinical presentation and show imaging findings of diaphragmatic hernias with variable visceral contents. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting anatomical structure and function. The commonest cause is excessive widening of the esophageal hiatus during surgery and, therefore, narrowing the hiatus to fit the conduit can prevent this complication.