This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Diaphragmatic herniation following oesophagectomy. BJS 1999; 86: 109-112.
Published: 2nd January 2003
Authors: J. W. van Sandick, J. L. Knegjens, J. J. B. van Lanschot, H. Obertop
Background
Intrathoracic herniation of abdominal viscera is a potentially life‐threatening condition, especially when diagnosis is delayed. The aim of this study was to estimate its incidence following oesophageal resection and to define contributing factors that might influence its occurrence.
Method
All radiographic studies of the chest that were made during follow‐up in a series of 218 patients who underwent oesophagectomy between 1993 and 1997 were reviewed.
Results
Herniation of bowel alongside the oesophageal substitute was detected in nine patients (4 per cent). Four hernias occurred within the first week after operation and five were detected at late follow‐up. Surgical treatment was indicated in six patients. Analysis of predisposing factors revealed that extended incision and partial resection of the diaphragm were associated with an increased risk of postoperative hernia formation (four of 29 following extended enlargement versus five of 189 after routine opening of the oesophageal hiatus; P = 0·02).
Conclusion
Diaphragmatic herniation was found in 4 per cent of patients after oesophagectomy. After extended iatrogenic disruption of the normal hiatal anatomy, narrowing of the diaphragmatic opening may be indicated to avoid postoperative herniation of bowel into the chest. Awareness of its possible occurrence may help prevent the development of intestinal obstruction and strangulation. © 1999 British Journal of Surgery Society Ltd
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