Thammineedi Subramanyeshwar Rao, Raju Kvvn, Patnaik Sujit Chyau, Saksena Ajesh Raj, Iyer R Rajagopalan, Sudhir Rashmi, Rayani Basanth Kumar, Smith Lynnette M, Are Chandrakanth, Nusrath Syed
Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India.
Department of Radiology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India.
Indian J Surg Oncol. 2021 Dec;12(4):729-736. doi: 10.1007/s13193-021-01415-4. Epub 2021 Aug 18.
This study's objective was to assess the presentation, incidence, operative approach, and outcomes of acute symptomatic post-esophagectomy diaphragmatic hernia (PEDH), following minimal access esophagectomy (MAE) for esophageal and gastro-esophageal junctional cancer. Between January 2010 and December 2020, all consecutive patients undergoing esophagectomy were retrospectively analyzed. Acute symptomatic PEDH occurred in 4 patients out of 680 consecutive patients undergoing esophagectomy (0.58%) and 636 MAE (0.63%). All patients were men, with a median age of 56.5 years, and underwent minimal access transhiatal resection. The presentation was varied; 2 had restlessness, agitation, and tachycardia; one acute respiratory distress; and the last was asymptomatic but had reduced air entry over left hemithorax with unexplained hypoxia. All had transverse colon herniation into the left hemithorax. Herniated viscera were reduced with closure of hiatal defect, 3 underwent laparoscopic repair, and one needed laparotomy. Meshplasty or bowel resection was not required. The median hospital stay was 9 days with no perioperative mortality. The major complications (Clavien-Dindo grade ≥ IIIa) occurred in 2 patients. One patient was lost to follow-up, 2 died of disease after a year and 15 months post-procedure, and one is doing well at 10 months without any relapse of hernia. Acute symptomatic PEDH is a rare complication after transhiatal esophagectomy and mainly occurs in the left hemithorax. The incidence appears to be less than 1% after MAE. Laparoscopic repair is feasible in most cases. We recommend routine assessment of hiatus and tightening of hiatus to snuggly accommodate the gastric conduit.
本研究的目的是评估在采用微创食管切除术（MAE）治疗食管和食管胃交界部癌后，急性症状性食管切除术后膈疝（PEDH）的表现、发生率、手术方式及预后。对2010年1月至2020年12月期间所有连续接受食管切除术的患者进行回顾性分析。在680例连续接受食管切除术的患者中，有4例发生急性症状性PEDH（0.58%），在636例行MAE的患者中，有4例发生（0.63%）。所有患者均为男性，中位年龄56.5岁，均接受了微创经裂孔切除术。表现各异；2例有烦躁不安、激动和心动过速；1例出现急性呼吸窘迫；最后1例无症状，但左半侧胸廓呼吸音减弱伴不明原因的低氧血症。所有患者均有横结肠疝入左半侧胸廓。通过关闭裂孔缺损还纳疝入的脏器，3例行腹腔镜修补术，1例需要开腹手术。无需进行补片修补或肠切除术。中位住院时间为9天，无围手术期死亡。2例患者发生主要并发症（Clavien-Dindo分级≥Ⅲa级）。1例患者失访，2例在术后1年和15个月死于疾病，1例在术后10个月情况良好，无疝复发。急性症状性PEDH是经裂孔食管切除术后的一种罕见并发症，主要发生在左半侧胸廓。MAE术后的发生率似乎低于1%。大多数情况下，腹腔镜修补术是可行的。我们建议常规评估裂孔并收紧裂孔，以紧密容纳胃管道。
