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. 2019 Feb 18;5(1):26.
doi: 10.1186/s40792-019-0578-9.

Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports

Takuji Sato  1 , Takeo Fujita  1 , Hisashi Fujiwara  1 , Hiroyuki Daiko  2
Affiliations

Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports

Takuji Sato et al. Surg Case Rep. .

Abstract

Background: Minimally invasive esophagectomy is considered a beneficial approach to esophageal cancer, although a hiatal hernia occurs more frequently in this approach than in open esophagectomy with reconstruction via the mediastinal route. Development of an internal hernia to the retrosternal space is not a recognized complication of reconstruction via the retrosternal route after esophagectomy. We herein report three cases of the development of an internal hernia to the retrosternal space after minimally invasive esophagectomy.

Case presentation: Thoracolaparoscopic esophagectomy with cervical anastomosis by retrosternal route reconstruction was performed in all three cases. All patients were men ranging in age from 60 to 80 years. Two patients had abdominal pain, and one had experienced syncope. All patients were diagnosed by computed tomography with an internal hernia to the retrosternal space and thoracic cavity (retrosternal hernia) without ischemic change to the incarcerated intestine. Two patients received medical therapy to relieve their intra-abdominal pressure, which allowed for a successful reduction of the intestine into the abdomen. Open laparotomy was performed to repair the hernia in the third patient. After reducing the intestine into the abdomen, reefing of the retrosternal orifice was performed, and the gastric conduit was anchored to the abdominal wall. No relapse occurred in three cases throughout follow-up.

Conclusion: Hiatal hernia is a well-recognized complication after minimally invasive esophagectomy; however, retrosternal hernia is a rare complication following this procedure. Based on the present report, if no ischemic change is present in the herniated intestine, two types of potentially curative treatments are available: medical or surgical. As minimally invasive esophagectomy is performed more frequently, retrosternal hernia may become an increasingly more common complication in the near future.

Keywords: Internal hernia; Minimally invasive esophagectomy; Retrosternal hernia; Retrosternal space.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable in our institutional ethics committee.

Consent for publication

Written informed consent for publication of the patients’ clinical details and clinical images was obtained from the patients.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Computed tomography findings of case 1. The axial image demonstrated that the intestine had been drawn into both thoracic cavities. The intestine pressed the gastric conduit, leading to obstruction and dilation. This dilated gastric conduit severely pressed the heart
Fig. 2
Fig. 2
Intraoperative photographs of case 1. a The small and large intestines were incarcerated in the retrosternal orifice. b The intestine was easily reduced into the abdomen. The retrosternal orifice was widely opened with a sharp edge
Fig. 3
Fig. 3
Computed tomography findings in case 2. a Computed tomography image obtained on the day of symptom onset. The intestine (red arrow) was dislocated only in the retrosternal space. b Computed tomography image obtained 2 days after symptom onset. The intestine had disappeared from the retrosternal space
See this image and copyright information in PMC

References

    1. Lv L, Hu W, Ren Y, Wei X. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. Onco Targets Ther. 2016;9:6751–6762. doi: 10.2147/OTT.S112105. - DOI - PMC - PubMed
    1. Oor JE, Wiezer MJ, Hazebroek EJ. Hiatal hernia after open versus minimally invasive esophagectomy: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(8):2690–2698. doi: 10.1245/s10434-016-5155-x. - DOI - PubMed
    1. Takayama T, Wakatsuki K, Matsumoto S, Enomoto K, Tanaka T, Migita K, et al. Intrathoracic hernia of a retrosternal colonic graft after esophagectomy: report of a case. Surg Today. 2011;41(9):1298–1301. doi: 10.1007/s00595-010-4501-z. - DOI - PubMed
    1. Uemura N, Abe T, Kawakami J, Hosoi T, Ito S, Shimizu Y. Clinical impact of intrathoracic herniation of gastric tube pull-up via the retrosternal route following esophagectomy. Dig Surg. 2017;34(6):483–488. doi: 10.1159/000456084. - DOI - PubMed
    1. Matthews J, Bhanderi S, Mitchell H, Whiting J, Vohra R, Hodson J, et al. Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?: post-operative diaphragmatic hernias. Surg Endosc. 2016;30(12):5419–5427. doi: 10.1007/s00464-016-4899-5. - DOI - PubMed

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