Giulini Luca, Avramovska Irina, Kemeter Melissa, Bernhardt Lisa, Thumfart Lucas, Hüttner Felix J, Heger Patrick, Hitzl Wolfgang, Diener Markus K, Dubecz Attila
Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.
BJS Open. 2025 Sep 8;9(5). doi: 10.1093/bjsopen/zraf095.
Hiatal hernia (HH) after oesophagectomy is a potentially life-threatening complication, more commonly observed after minimally invasive procedures. The aim of the study was to compare the incidence of HH after open versus minimally invasive oesophagectomy (MIO) for cancer, to identify risk factors for its onset, and analyse the technical differences between the approaches.
This was a retrospective study of patients who underwent transthoracic oesophagectomy for cancer over a 15-year period. Open and minimally invasive procedures were compared according to demographics, and operative and perioperative parameters. MIO included both laparoscopic and robotic operations. Risk factors for HH after oesophagectomy were analysed by calculating odds ratios of uni- and multivariable generalized linear models.
A total of 898 patients operated on between 2008 and 2023 were included in the study. HH was observed in 1 of 490 patients (0.2%) in the open group and in 21 of 408 patients (5.2%) in the minimally invasive group (P < 0.001). At multivariable analysis, patients with an ASA score of II and III within the MIO group had a significantly lower risk of HH compared with ASA I subjects (P = 0.002 and P < 0.001, respectively). Omentectomy was performed in all open procedures but in none of the MIO.
The rate of HH was significantly lower in patients who underwent open oesophagectomy. Omentectomy may prevent postoesophagectomy HH as it was the only additional technical difference between the groups. Multicentric randomized clinical trials are needed to assess whether omentectomy during MIO may reduce the occurrence of paraconduit HH.
食管癌切除术后的食管裂孔疝（HH）是一种潜在的危及生命的并发症，在微创手术后更为常见。本研究的目的是比较开放性与微创食管癌切除术（MIO）治疗癌症后HH的发生率，确定其发病的危险因素，并分析两种手术方式的技术差异。
这是一项对15年间接受经胸食管癌切除术患者的回顾性研究。根据人口统计学、手术及围手术期参数对开放性手术和微创手术进行比较。MIO包括腹腔镜手术和机器人手术。通过计算单变量和多变量广义线性模型的比值比分析食管癌切除术后HH的危险因素。
本研究纳入了2008年至2023年间接受手术的898例患者。开放手术组490例患者中有1例（0.2%）发生HH，微创组408例患者中有21例（5.2%）发生HH（P<0.001）。多变量分析显示，MIO组中ASA评分为II级和III级的患者发生HH的风险明显低于ASA I级患者（分别为P = 0.002和P<0.001）。所有开放性手术均行网膜切除术，而MIO手术均未行网膜切除术。
接受开放性食管癌切除术的患者HH发生率明显较低。网膜切除术可能预防食管癌切除术后HH，因为这是两组之间唯一的额外技术差异。需要进行多中心随机临床试验来评估MIO期间行网膜切除术是否可减少食管旁HH的发生。
