Hiatal hernia after oesophagectomy: a large European survey.

Details

Serval ID
serval:BIB_16A60769B8A1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Hiatal hernia after oesophagectomy: a large European survey.
Journal
European journal of cardio-thoracic surgery
Author(s)
Gust L., Nafteux P., Allemann P., Tuech J.J., El Nakadi I., Collet D., Goere D., Fabre J.M., Meunier B., Dumont F., Poncet G., Passot G., Carrere N., Mathonnet M., Lebreton G., Theraux J., Marchal F., Barabino G., Thomas P.A., Piessen G., D'Journo X.B.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
01/06/2019
Peer-reviewed
Oui
Volume
55
Number
6
Pages
1104-1112
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Hiatal hernias (HH) after oesophagectomy are rare, and their surgical management is not well standardized. Our goal was to report on the management of HH after oesophagectomy in high-volume tertiary European French-speaking centres.
We conducted a retrospective multicentre study among 19 European French-speaking departments of upper gastrointestinal and/or thoracic surgery. All patients scheduled or operated on for the repair of an HH after oesophagectomy were collected between 2000 and 2016. Demographics, details of the initial procedure, surgical management and long-term outcome were analysed.
Seventy-nine of 6608 (1.2%) patients who had oesophagectomies were included in the study. The postoesophagectomy diagnostic interval of an HH after oesophagectomy was ≤90 days (n = 17; 21%), 13 were emergency cases; between 91 days and 1 year, n = 21 (27%), 13 in emergency; ≥1 year, n = 41 (52%), 17 in emergency. The time to occurrence of HH after oesophagectomy was shorter after laparoscopy (median 308 days; interquartile range 150-693) compared to that after laparotomy (median 562 days, interquartile range 138-1768; P = 0.01). The incidence of HH after oesophagectomy was 0.73% (22/3010) after open surgery and 1.4% (26/1761) after laparoscopy (P = 0.03). Among the 79 patients, 78 were operated on: 35 had laparotomies (45%), 19 had laparoscopies (24%) and 24 (31%) had transthoracic approaches. Among the 43 urgent surgeries, 35 were open (25 laparotomies and 10 transthoracic approaches) and 8 were laparoscopies (conversion rate, 25%). Nine patients required bowel resections. Morbidity occurred in 36 (46%) patients with 1 postoperative death (1.2%). During the follow-up period, recurrent HH after oesophagectomy requiring revisional surgery developed in 8 (6 days-26 months) patients.
Surgical management of HH after oesophagectomy could be done by laparoscopy in patients with scheduled surgery but laparotomy or thoracotomy was preferred in urgent situations. The incidence of HH after oesophagectomy is higher and its onset earlier when laparoscopy is used at the initial oesophagectomy.
Keywords
Complications, Diaphragmatic hernia, Hiatal hernia, Oesophagectomy, Surgery
Pubmed
Create date
23/01/2019 10:53
Last modification date
21/08/2019 5:36
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