Hiatal Hernia After Esophagectomy: Analysis of 2,182 Esophagectomies From a Single Institution

Background. Esophageal resection is a complex operation often associated with morbidity. Hiatal hernia after esophagectomy is an unusual complication. We reviewed our experience with this complication. Methods. From February 1988 through February 2009 we performed 2,182 esophagectomies. Fifteen (0.69%) patients experienced a hiatal hernia. We reviewed our prospective database for demographics, presentation, operative approaches, and outcomes. Results. There were 14 men and 1 woman with a mean age of 59 years. Hernia developed after Ivor Lewis approach in 9, transhiatal in 5, and substernal colon interposition in 1. Presenting symptoms included pain in 7 patients, obstructive symptoms in 5, high chest tube output in 2, shortness of breath in 2, diarrhea in 1, and cough with dysphagia in 1. Two patients were asymptomatic. Radiographic studies revealed bowel in the left chest in 11 patients, right chest in 2, bilaterally in 1, and posterior mediastinum in 1. Hernia repair was through the abdomen in 14 patients and left chest in 1. All had reduction of the herniated contents and closure of the defect; 2 required mesh. There was no early mortality. Complications included wound infection, deep venous thrombosis, chylothorax, urinary retention, sacral decubiti, atrial arrhythmias, respiratory failure, and empyema. Mean follow-up was 34 months. Ten patients are still alive. There have been two hernia recurrences. Conclusions. Hiatal hernia after esophagectomy is rare. Repair can be accomplished with low mortality; however, there is substantial morbidity. Because of the increased risk of incarceration or strangulation, these herniae should be repaired. Long-term outcome is usually excellent.