Hiatal Hernia after Esophagectomy: An Underappreciated Complication?

Background The natural history of hiatal herniation of small and/or large bowel post esophagectomy (HHBPE), in the current era of improving long term survival and evolving surgical technique, is unknown. The aim of this study is to describe the rate and risk factors of HHBPE at our hospital. Methods Patients undergoing esophagectomy between January, 2011 and June, 2017 were included if both follow up information and axial imaging were available beyond 3 months post esophagectomy. Patient characteristics, disease information, and treatment factors were all included in univariate analysis comparing patients with and without HHBPE, and multivariate regression was used to identify significant independent risk factors associated with HHBPE. Results Out of 310 esophagectomy patients analyzed, 258 patients were included in the study, with 79 patients (31%) showing evidence of a HHBPE and an overall median follow-up of 24 months; 44/79 (56%) had symptoms possibly referable to HHBPE and 17/79 (22%) underwent surgical repair. On univariate analysis, neoadjuvant therapy (n = 176), higher clinical stage, minimally invasive approach (n = 154), and transhiatal esophagectomy (n = 189) were significant predictors of HHBPE (p Conclusions HHBPE in the current era of neoadjuvant therapy and minimally invasive esophagectomy is common. HHBPE may cause GI symptoms but operation to repair HHBPE is uncommon on intermediate follow up. Further study and long-term follow are required to fully assess the impact of HHBPE and to potentially modify surgical practice to prevent or minimize HHBPE.