Ryabov A B, Pikin O V, Khomyakov V M, Kolobaev I V, Abdulkhakimov N M
Herzen Moscow Oncology Research Institute, Moscow, Russia.
Khirurgiia (Mosk). 2024(11):24-29. doi: 10.17116/hirurgia202411124.
To analyze the causes and surgical treatment of hiatal hernia after esophagectomy, technical features of surgery and methods of prevention.
We retrospectively analyzed the incidence of postoperative hiatal hernias after esophagectomy in patients with esophageal cancer between 2018 and 2023. Structure of hernias, surgical options and postoperative results were assessed.
We analyzed 161 patients after Ivor Lewis (=101) and McKeown (=60) esophagectomies (open surge surgeries - 43.5%, thoraco- and laparoscopic procedures - 23%, hybrid procedures - 33.5%). The incidence of postoperative hiatal hernia was 3.7%. Hernia occurred within 1-15 months. There were 5 men and 1 woman (mean age 65 years). In all cases, partial or complete dissection of the left diaphragmatic crura was performed. The incidence of hernia after minimally invasive surgery was 4.4%, after open surgery - 2.9%. Two (33.3%) patients underwent urgent surgery for ileus within 2 months after primary esophageal surgery. Three (50%) patients underwent elective surgery. One (16.6%) patient is currently followed-up. The complication was asymptomatic in 2 (33.3%) patients. One (16.6%) patient died after emergency surgery in a COVID hospital due to strangulated hernia and progressive respiratory failure. Mean follow-up period was 16 months. No recurrent hernias were diagnosed.
Hiatal hernias occur 2 times more often after minimally invasive esophagectomies. Active surgical strategy is necessary for symptomatic hernias due to high risk of strangulation and emergency interventions. The incidence of this complication is lower without wide diaphragmotomy, transection of the left diaphragmatic crus and high abdominal pressure during laparoscopic stage.
分析食管癌切除术后食管裂孔疝的病因、手术治疗方法、手术技术特点及预防措施。
回顾性分析2018年至2023年食管癌患者食管癌切除术后食管裂孔疝的发生率。评估疝的结构、手术选择及术后结果。
我们分析了161例接受艾弗·刘易斯（n = 101）和麦克尤恩（n = 60）食管癌切除术的患者（开放手术 - 43.5%，胸腔镜和腹腔镜手术 - 23%，混合手术 - 33.5%）。术后食管裂孔疝的发生率为3.7%。疝在1至15个月内出现。有5名男性和1名女性（平均年龄65岁）。所有病例均进行了左侧膈肌脚的部分或完全解剖。微创手术后疝的发生率为4.4%，开放手术后为2.9%。两名（33.3%）患者在初次食管手术后2个月内因肠梗阻接受了急诊手术。三名（50%）患者接受了择期手术。一名（16.6%）患者目前正在随访中。2名（33.3%）患者的并发症无症状。一名（16.6%）患者在新冠医院急诊手术后因绞窄性疝和进行性呼吸衰竭死亡。平均随访期为16个月。未诊断出复发性疝。
微创食管癌切除术后食管裂孔疝的发生率高出2倍。由于绞窄和急诊干预的高风险，对于有症状的疝，积极的手术策略是必要的。在腹腔镜阶段不进行广泛的膈肌切开、左侧膈肌脚横断和高腹压时，这种并发症的发生率较低。
