Postoperative incidence of incarcerated hiatal hernia and its prevention after robotic transhiatal esophagectomy

Transhiatal robot-assisted total esophagectomy (RE) has gained acceptance as a minimally invasive procedure with several clinical benefits. In this report, the authors describe their experience with the incidence of incarcerated hiatal hernia after RE. Between March 2007 and July 2009, 36 patients underwent RE at the authors' institution. A retrospective chart review was performed, and data were abstracted including gender, age, weight at surgery, presenting symptoms, pathologic diagnosis, operative time, estimated blood loss, mortality, and postoperative complications. The study cohort consisted of 28 men and 8 women undergoing RE. Their average age was 65.4 +/- A 10.5 years, and their mean body weight was 86.2 +/- A 24.8 kg at surgery. A review of medical records indicated that 7 (19.4%) of the 36 patients had postoperative incarcerated hiatal hernias. Two of these patients had experienced two episodes of incarceration, which required reoperation. One patient died of complications related to hernia repair. Six (85.7%) of 7 patients had a preexisting diagnosis of hiatus hernia which was significantly higher in comparison to the incidence of this complication within the group of 29 patients without post-operative hernia incarcerations (11 of 29, 37.9%; Fisher's exact p = 0.04). The results indicate that postoperative incarcerated hiatal hernia after RE is an infrequently reported, albeit serious, complication. A preexisting hiatal hernia may put patients at a higher risk of incarceration. According to the authors' experience, a primary closure and reinforcement with mesh sutured to the gastric wall is recommended as a preventive measure. Diligent follow-up evaluation with regular computed tomography (CT) scans investigating likelihoods for incarceration is advisable, especially for patients with preexisting hernias.