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Caractéristiques des hernies diaphragmatiques après œsophagectomie pour cancer

Authors
  • Audebert, A.
  • Wind, P.
  • Sauvanet, A.
  • Douard, R.
  • Benichou, J.
  • Cugnenc, P.-H.
  • Belghiti, J.
Type
Published Article
Journal
Annales de Chirurgie
Publisher
Elsevier
Publication Date
Jan 01, 2004
Volume
130
Issue
1
Pages
21–25
Identifiers
DOI: 10.1016/j.anchir.2004.09.003
Source
Elsevier
Keywords
License
Unknown

Abstract

Introduction. – Diaphragmatic hernia is a rare complication of oesophagectomy for cancer. We report a series of seven patients to determine characteristics of this entity. Patients and methods. – Seven patients (six male and one female, 61 to 68 years old) were operated on for diaphragmatic hernia following oesophagectomy for carcinoma (adenocarcinoma N =4, squamous-cell carcinoma N =3). Oesophagectomy had been performed through abdominal transhiatal approach in four patients and transthoracically in three, with hiatal enlargement in all cases. Results. – Three patients, all symptomatic, underwent emergency surgery within two years following oesophagectomy. Of the four patients operated between two and seven years after oesophagectomy, two were symptomatic. Presence of symptoms were neither related with technique of oesophagectomy, nor to type of hiatal enlargement (anterior, or by crura division). All patients with hernia containing small bowel were symptomatic. All patients were operated through abdominal approach. Hernia contained colon three times, small bowel once, and both three times. Hernia reduction needed additional phrenotomy in six patients. Two patients underwent colectomy to treat peroperative colonic ischemia. Diaphragmatic hiatus was calibrated around the gastric tube by direct suture in six patients or with absorbable mesh in one. There was no death. No recurrences occurred with a follow up ranging from one to five years. Conclusion. – The diaphragmatic hernia after œsophagectomy is due to excessive hiatal enlargement. Hernias occurring early after oesophagectomy are badly tolerated and need urgent reoperation. To prevent this complication of oesophagectomy, we advocate calibration of diaphragmatic hiatus fit to width of gastroplasty.

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