Laparoscopic Treatment of Diaphragmatic Hernia After Transthoracic Esophagectomy

Elena Orsenigo; Carlo Staudache; Saverio Di Palo

Product Details
Product ID: ACS-2965
Year Produced: 2009
Length: 6 min.


Hiatal hernia can occur in the early postoperative period or as a late complication of transthoracic esophagectomy.

A 55 year old female with a past medical history of GERD, underwent a transthoracic esophagectomy with laparoscopic gastroplasty for ypT2N0M0R0 squamocellular carcinoma of the lower esophagus in September 2008, after neoadjuvant therapy. Three months after surgery the patient suffered abdominal pain and severe constipation. A CT of the abdomen demonstrated a colonic loop in the left hemi thorax, with free fluid. The patient proceeded to laparoscopy where findings included intrathoracic free fluid and the presence of the transverse colon within the hernia. The herniated bowel was reduced into the abdominal cavity. There were few adhesions between the bowel loop and the surrounding structures. No hernial sac was present separating abdominal and thoracic contents. Care was taken posteriorly and on the right side where the gastric tube conduit passed into the right thoracic cavity. The defect in the diaphragm was closed with nonabsorbable sutures.

The patient made an uneventful postoperative recovery. The patient has been discharged in the 5th postoperative day. The patient is well and free of hernia recurrence 2 months after surgery.

Transhiatal herniation of colon is uncommon after esophagectomy. With an increase in the number of minimally invasive esophagectomies performed each year, it is likely that the number of patients presenting with such a complication will increase. It is therefore important that surgeons and patients are aware of this potentially serious complication.