Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France.
Department of Thoracic Surgery and Disease of the Esophagus, KUZ Gathuisberg, Leuven, Belgium.
Eur J Cardiothorac Surg. 2019 Jun 1;55(6):1104-1112. doi: 10.1093/ejcts/ezy451.
Hiatal hernias (HH) after oesophagectomy are rare, and their surgical management is not well standardized. Our goal was to report on the management of HH after oesophagectomy in high-volume tertiary European French-speaking centres.
We conducted a retrospective multicentre study among 19 European French-speaking departments of upper gastrointestinal and/or thoracic surgery. All patients scheduled or operated on for the repair of an HH after oesophagectomy were collected between 2000 and 2016. Demographics, details of the initial procedure, surgical management and long-term outcome were analysed.
Seventy-nine of 6608 (1.2%) patients who had oesophagectomies were included in the study. The postoesophagectomy diagnostic interval of an HH after oesophagectomy was ≤90 days (n = 17; 21%), 13 were emergency cases; between 91 days and 1 year, n = 21 (27%), 13 in emergency; ≥1 year, n = 41 (52%), 17 in emergency. The time to occurrence of HH after oesophagectomy was shorter after laparoscopy (median 308 days; interquartile range 150-693) compared to that after laparotomy (median 562 days, interquartile range 138-1768; P = 0.01). The incidence of HH after oesophagectomy was 0.73% (22/3010) after open surgery and 1.4% (26/1761) after laparoscopy (P = 0.03). Among the 79 patients, 78 were operated on: 35 had laparotomies (45%), 19 had laparoscopies (24%) and 24 (31%) had transthoracic approaches. Among the 43 urgent surgeries, 35 were open (25 laparotomies and 10 transthoracic approaches) and 8 were laparoscopies (conversion rate, 25%). Nine patients required bowel resections. Morbidity occurred in 36 (46%) patients with 1 postoperative death (1.2%). During the follow-up period, recurrent HH after oesophagectomy requiring revisional surgery developed in 8 (6 days-26 months) patients.
Surgical management of HH after oesophagectomy could be done by laparoscopy in patients with scheduled surgery but laparotomy or thoracotomy was preferred in urgent situations. The incidence of HH after oesophagectomy is higher and its onset earlier when laparoscopy is used at the initial oesophagectomy.
食管切除术后的食管裂孔疝（HH）很少见，其手术治疗尚未得到很好的规范。我们的目标是报告在高容量的欧洲法语三级中心对食管切除术后 HH 的治疗情况。
我们对 19 个欧洲法语的上消化道和/或胸外科部门进行了回顾性多中心研究。在 2000 年至 2016 年期间，收集了所有计划或接受食管切除术后 HH 修复的患者。分析了人口统计学、初始手术细节、手术管理和长期结果。
在 6608 例接受食管切除术的患者中，79 例（1.2%）被纳入研究。食管切除术后 HH 的术后诊断间隔时间≤90 天（n=17；21%），其中 17 例为急诊；91 天至 1 年（n=21；27%），其中 13 例为急诊；≥1 年（n=41；52%），其中 17 例为急诊。与开腹手术相比，腹腔镜手术后 HH 发生的时间更短（中位时间 308 天；四分位距 150-693）（中位数 562 天，四分位距 138-1768；P=0.01）。开腹手术 HH 发生率为 0.73%（22/3010），腹腔镜手术为 1.4%（26/1761）（P=0.03）。在 79 例患者中，78 例接受了手术治疗：35 例行开腹手术（45%），19 例行腹腔镜手术（24%），24 例行经胸手术（31%）。在 43 例紧急手术中，35 例为开腹手术（25 例开腹手术和 10 例经胸手术），8 例为腹腔镜手术（转换率为 25%）。9 例患者需要肠切除术。36 例（46%）患者发生了并发症，其中 1 例死亡（1.2%）。在随访期间，8 例（6 天-26 个月）患者需要再次手术治疗复发性食管切除术后 HH。
在计划手术时，可以通过腹腔镜手术治疗食管切除术后 HH，但在紧急情况下，更倾向于开腹或经胸手术。当在初始食管切除术时使用腹腔镜时，HH 的发生率更高，发病时间更早。
