Hiatus Hernia post oesophagectomy for oesophageal cancer: incidence & outcomes

Abstract Background The development of a hiatus hernia following oesophagectomy is a well-documented occurrence. The aim of this study is to examine the incidence of hiatus hernia formation, the symptoms patient present with and differences between open and laparoscopic/minimally invasive surgery. Methods A dataset containing data on all patients from an upper GI regional tertiary referral centre were analysed. All subsequent patients who underwent oesophagectomy between Nov 2014 and Nov 2020 were included. Results A total of 268 patients underwent oesophagectomy over this time, of whom 81.0% (n = 217/268) were male and the median age was 68 years old (62-73 years). The median BMI at the time of operation was 27.6Kg/m2 (IQR 24.6-30.7Kg/m2). Over a median follow up of 12 months (IQR 5-21), 4.5% (n = 12/268) developed a hiatus hernia. Amongst these 12, the most common organ in the hernia was the transverse colon (66.7%, n = 8/12) and the small bowel (n = 3). The most reported symptoms in those with a hiatus hernia were respiratory symptoms (cough/breathlessness: n = 5), reflux (n = 3), vomiting (n = 3) and chest pain (n = 3). There was no correlation between BMI and the occurrence of a hiatus hernia (p = 0.145) nor were there differences across males and females in terms of hiatus hernia rates (p = 0.845). In patients who had prophylactic repair of the diaphragm (n = 126/268, 47.0%) the rate of hernia repair was no different (4.8%) compared with those who did not have a prophylactic diaphragmatic repair with sutures (4.2%, p = 0.832). There was however a correlation between the volume of intraoperative blood loss and the occurrence of a hiatus hernia, with increasing blood loss correlating with a higher likelihood of hernia occurrence (r = 0.295, p = 0.037). Conclusions Hiatus hernia is a relatively common occurrence after oesophageal cancer surgery, with most patients suffering from chest symptoms, pain, and reflux. Intra-operative blood loss may influence the chances of developing a hiatus hernia. Prophylactic measures such as reinforcing the diaphragm or hiatus with sutures, do not appear to affect hernia rates.