Eastern Cardiothoracic Surgical Society

Paraesophageal Hernia Following Esophagectomy
Brian J. Fazzone1, Summer N. Rochester2, Sharon Ben-Or2, Alfredo Carbonell2, William Cobb2, Alex Ewing2, Allyson L. Hale2, James E. Stephenson2, Jeremy Warren2, William D. Bolton2, 1University of South Carolina School of Medicine, Greenville, SC, 2Greenville Health System, Greenville, SC

OBJECTIVE: Paraesophageal hernia (PEH) following esophagectomy is an uncommon and possibly under-reported complication. Patients may be asymptomatic, or experience variable PEH-related complications. Our study aims to describe the incidence, presentation, and complications seen in patients with PEH after esophagectomy at our institution.

METHODS: We performed a retrospective review of all patients who underwent esophagectomy at our tertiary hospital between 2006 and 2016. Primary endpoint was rate of PEH; secondary endpoints included time to discovery and complications associated with PEH. An independent radiologist review was conducted on our patient's imaging to identify previously undiagnosed PEHs.

RESULTS: During our study period, 137 patients underwent esophagectomy. Overall incidence of PEH was 5.8% [7.8% after minimally invasive, 2.1% after open], with an average time to discovery of 18.5 months [1-34 months]. From the eight patients with PEH, three were asymptomatic and five were symptomatic upon discovery. Two patients presented emergently, with one dying as a result of his PEH. The other four symptomatic patients elected to have repair, whereas no asymptomatic patients elected to undergo repair. Three of the patients who underwent repair are now asymptomatic. The three asymptomatic patients remain asymptomatic with an average of 55 months follow-up after PEH discovery. No PEHs were missed upon radiologist review of patients most recent CT scans.

CONCLUSIONS: We found a similar time to discovery as well as rates of PEH after laparoscopic and open esophagectomy as those reported in the literature. Different from previous reports, we found no missed PEHs upon review of patient's follow-up imaging studies.