Short summary

Minimally invasive surgery for oesophageal malignancy is emerging as an alternative to traditional open surgery. With this new type of surgery, new types of complications occur. Hiatal hernia is a potential life-threatening complication and the incidence seems to be higher compared to open surgery. In this study we attemp to establish the incidence of hiatal hernia after both open and minimally invasive oesophagectomy in a large single centre cohort. 

Rationale

Minimally invasive oesophagectomy (MIO) for the treatment of oesophageal cancer has emerged as an alternative to traditional open oesophagectomy yielding less pulmonary complications, shorter length of stay and better short-term quality of life without compromising disease free or overall survival. 

HH of abdominal viscera other than the gastric/colonic conduit is an infrequent but potentially life-threatening complication following oesophagectomy and can be asymptomatic.  Operative hernia repair is recommended, especially in case of symptomatic herniation or a progressive increase in the size of HH. More importantly, HH may also present with grievous complications, such as severe respiratory failure, intestinal ischemia with perforation, bowel obstruction, and strangulation leading to emergency surgery. Both radiologists and surgeons should be aware of this potentially life-threatening complication.

Surgical repair of these HHs is associated with a high morbidity rate and in the emergent setting even a high mortality. Although the outcome after HH repair was reported in less than half of the studies included in a recent the systematic review, the pooled morbidity rate was 25% and the recurrence rate 14%.  

In the abovementioned meta-analysis, the pooled incidence of symptomatic HH after MIO was 4.5 %, compared to a pooled incidence of 1.0 % after open oesophagectomy. However, this systematic review identified only one prospective (n=50, 6% asymptomatic HH) and one randomized controlled trial (n=56, 3.6% asymptomatic HH) out of the included 26 studies, and the actual HH incidence may have been underestimated.

Investigating incidence, treatment and consequence of HH after MIO is becoming more relevant due to an increased number of minimal invasive procedures being performed.  No evidence-based consensus exists on when or how to close the hiatal crura and no prospective studies have been performed evaluating the potential risk factors for herniation

Description of the cohort

All patients who have undergone intended curative oesophageal resection for malignant disease at The Department of Surgery, Odense University Hospital, from 1th January 2012 - 31th December 2018. 

Data and biological material

Data on patient demography, perioperative parameters and occurence of hiatal hernia will be collected from patient records. 

Collaborating researchers and departments

Department of Surgery, Odense University Hospital

• Consultant, Michael Hareskov Larsen, MD, PhD 
• Speciality Registrar, Nicolaj Marcus Stilling, MD
• Registrar, Jonas Sanberg Ljungdalh, MD