BACKGROUND Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE). METHODS The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH. RESULTS Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p = 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p < 0.001). In-hospital deaths were solely seen after emergency operations (19%). CONCLUSIONS HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.

中文翻译：

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癌症食管切除术后的食管裂孔疝。


背景 由于生存率的提高，食管切除术后的食管裂孔疝 (HH) 变得越来越重要。本研究评估并比较了开放式微创食管切除术 (MIE) 后 HH 的发生和临床病程。方法 对 2000 年至 2014 年间在英国和荷兰的 2 个三级转诊中心接受食管癌切除术治疗的患者的前瞻性记录特征进行了回顾。审查计算机断层扫描报告以确定 HH。结果 在 657 名患者中，432 名患者 (66%) 进行了 MIE，225 名患者 (34%) 进行了开放性食管切除术。对 488 名患者 (74%) 进行了计算机断层扫描。 45 名患者在中位 20 个月（范围：0 至 101 个月）后被诊断为 HH。 MIE 后 HH 的发展与开放方法相当（8% vs 5%，p = 0.267）。诊断时，有 14 名患者因外科急症就诊。其余31名患者中，17名有症状，14名无症状。 10名有症状的患者进行了择期手术，其余患者均进行了保守治疗。在保守治疗期间，2 名患者出现外科急症。与择期手术相比，紧急手术导致重症监护室住院时间延长（3 天 vs 0 天，p < 0.001）。院内死亡仅发生在紧急手术后（19%）。结论 HH 是食管切除术后重要的长期并发症，发生在相当大比例的患者中。 MIE 和开放食管切除术后 HH 的发生率相当。紧急手术会导致不良后果，应避免。