Increased risk of diaphragmatic herniation following esophagectomy with a minimally invasive abdominal approach

Lee, AHH; Oo, J; Cabalag, CS; Link, E; Duong, CP

Author(s): Lee, AHH; Oo, J; Cabalag, CS; Link, E; Duong, CP;
Details: Publication Year 2022-06-15,Volume 35,Issue #6,Page doab066
Journal Title: Diseases of the Esophagus
Publication Type: Review
Abstract: OBJECTIVE: Diaphragmatic herniation is a rare complication following esophagectomy, associated with risks of aspiration pneumonia, bowel obstruction, and strangulation. Repair can be challenging due to the presence of the gastric conduit. We performed this systematic review and meta-analysis to determine the incidence and risk factors associated with diaphragmatic herniation following esophagectomy, the timing and mode of presentation, and outcomes of repair. METHODS: A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed using four major databases. A meta-analysis of diaphragmatic herniation incidence following esophagectomies with a minimally invasive abdominal (MIA) approach compared with open esophagectomies was conducted. Qualitative analysis was performed for tumor location, associated symptoms, time to presentation, and outcomes of postdiaphragmatic herniation repair. RESULTS: This systematic review consisted of 17,052 patients from 32 studies. The risk of diaphragmatic herniation was 2.74 times higher in MIA esophagectomy compared with open esophagectomy, with pooled incidence of 6.0% versus 3.2%, respectively. Diaphragmatic herniation was more commonly seen following surgery for distal esophageal tumors. Majority of patients (64%) were symptomatic at diagnosis. Presentation within 30 days of operation occurred in 21% of cases and is twice as likely to require emergent repair with increased surgical morbidity. Early diaphragmatic herniation recurrence and cardiorespiratory complications are common sequelae following hernia repair. CONCLUSIONS: In the era of MIA esophagectomy, one has to be cognizant of the increased risk of diaphragmatic herniation and its sequelae. Failure to recognize early diaphragmatic herniation can result in catastrophic consequences. Increased vigilance and decreased threshold for imaging during this period is warranted.
Publisher: Oxford University Press
Keywords: *Esophageal Neoplasms/complications; Esophagectomy/adverse effects/methods; *Hernia, Diaphragmatic/epidemiology/etiology/surgery; Humans; *Laparoscopy/methods; Minimally Invasive Surgical Procedures/adverse effects; Postoperative Complications/epidemiology/etiology/surgery; Retrospective Studies; diaphragmatic hernia; esophagectomy; minimally invasive
Department(s): Surgical Oncology; Biostatistics and Clinical Trials
PubMed ID: 34549284
Publisher's Version: https://doi.org/10.1093/dote/doab066
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-01-17 02:00:43

Last Modified: 2025-01-17 02:02:19