Post-esophagectomy hiatal hernia following minimally invasive esophagectomy in esophageal cancer patients.

Introduction: Minimally invasive esophagectomy (MIE) has emerged as the preferred surgical method for esophageal cancer resulting from lower morbidity rates for MIE compared to open surgery. However, post-esophagectomy hiatal hernia (PEHH), also known as paraconduit hernia, once rare, is now increasingly observed as a late complication. This study aims to ascertain the prevalence, predictive factors, and surgical management of PEHH following MIE in esophageal cancer patients.

Methods: We retrospectively reviewed esophageal cancer patients who underwent MIE between 2013 and 2023. Patients with PEHH were identified through clinical presentation and CT scans and compared to those without PEHH using statistical tests. Variables with p-values less than 0.2 were subjected to multivariate analysis.

Results: Among 371 patients, predominantly male with locally advanced disease (stages 2-4, 90.8%), 25 (6.7%) developed PEHH after a median interval of 24 months post-MIE. The PEHH group exhibited significantly lower BMI and shorter ICU stays. On multivariate analysis BMI < 25 kg/m2 (OR 2.96, CI 1.22-7.20, p = 0.02) and ICU stays (OR 0.67, CI 0.47-0.96, p = 0.03) were independent predictors of PEHH. Surgical repair was performed in 84% of PEHH cases, with 60% symptomatic and 48% emergency surgery. The minimally invasive approach was implemented in 15 patients (71.4%). Primary repair was successfully conducted in 14 cases (66.7%), while mesh was used in one-third of patients.

Conclusion: The increasing prevalence of PEHH with MIE warrants attention. A lower BMI and shorter ICU stay was associated with PEHH. Most cases are symptomatic and effectively managed through minimally invasive techniques.