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Meta-Analysis
. 2021 Sep;406(6):1819-1829.
doi: 10.1007/s00423-021-02214-9. Epub 2021 Jun 15.

Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

Davide Bona  1 , Francesca Lombardo  1 , Kazuhide Matsushima  2 , Marta Cavalli  3 , Valerio Panizzo  1 , Paolo Mendogni  4 , Gianluca Bonitta  1 , Giampiero Campanelli  3 , Alberto Aiolfi  5
Affiliations
Meta-Analysis

Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis

Davide Bona et al. Langenbecks Arch Surg. 2021 Sep.

Abstract

Introduction: The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer.

Materials and methods: Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted.

Results: Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0-22.0%), 1.4% (95% CI = 0.8-2.2%), 35% (95% CI = 20.0-54.0%), and 5.0% (95% CI = 3.0-8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0-21.6%).

Conclusions: Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.

Keywords: Esophagectomy; Gastrectomy; Hiatus hernia; Outcomes; Trans-diaphragmatic herniation.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist (PRISMA) diagram
Fig. 2
Fig. 2
Forest plot (A) and funnel plot (B) for overall complications
Fig 3
Fig 3
Forest plot (A) and funnel plot (B) for in-hospital mortality
See this image and copyright information in PMC

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