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Diaphragmatic herniation following total gastrectomy: review of the long-term experience of a tertiary institution

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Abstract

Purpose

Diaphragmatic herniation (DH) is a rare but potentially fatal event after total gastrectomy (TG). Despite being life-threatening, risk factors for postoperative DH have yet to be elucidated. We conducted a retrospective analysis to identify clinical characteristics of patients developing DH after TG, along with a comprehensive review of the published literature.

Methods

Among 1361 consecutive patients undergoing TG for esophagogastric cancer between 1985 and 2013 in Toranomon Hospital, those requiring surgical intervention for postoperative DH were included. We also conducted a PubMed literature search on DH following TG.

Results

Five patients (four males, one female), with a median age of 68 at DH surgery, were identified. Intervals between TG and DH repair ranged from 2.9 to 189.0 (median, 78.1) months. Four patients had needed emergency surgery. Three patients had undergone open TG and two others laparoscopic TG, suggesting a significantly higher incidence of DH after laparoscopic TG (3/1302 vs. 2/59, p = 0.017). The diaphragmatic crus incision, creating the space for esophagojejunostomy, had been performed in all cases. The literature yielded seven relevant publications (16 patients). Intervals between TG and DH reduction ranged from 2 days to 36 months. All operations for DH had been carried out emergently.

Conclusion

The risk of DH persisted after TG. DH is potentially a very late complication of TG, presenting as a surgical emergency. Laparoscopic TG was suggested to be a risk factor for postgastrectomy DH. Incising the crus might also be a predictor of DH. Measures to prevent DH, e.g., appropriate closure of the crus, would be recommended in minimally invasive TG.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Article  Google Scholar 

  2. Lehnert T, Buhl K (2004) Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 91:528–539

    Article  CAS  Google Scholar 

  3. Kang KM, Cho YS, Min SH, Lee Y, Park KB, Park YS, Ahn SH, Park DJ, Kim HH (2019) Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era. Gastric Cancer 22:1009–1015

    Article  Google Scholar 

  4. Toriumi T, Makuuchi R, Kamiya S, Tanizawa Y, Bando E, Terashima M (2019) Obesity is a risk factor for internal hernia after laparoscopic or robot-assisted gastrectomy with mesenteric defect closure for gastric cancer. Surg Endosc:1–7. https://doi.org/10.1007/s00464-019-06787-x

  5. Kelly KJ, Allen PJ, Brennan MF, Gollub MJ, Coit DG, Strong VE (2013) Internal hernia after gastrectomy for cancer with Roux-en-Y reconstruction. Surgery 154:305–311

    Article  Google Scholar 

  6. Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T, Kimura Y, Fujiwara Y, Mori M, Doki Y (2012) Recent trend of internal hernia occurrence after gastrectomy for gastric cancer. World J Surg 36:851–857

    Article  Google Scholar 

  7. Kitagawa Y, Uno T, Oyama T, Kato K, Kato H, Kawakubo H, Kawamura O, Kusano M, Kuwano H, Takeuchi H, Toh Y, Doki Y, Naomoto Y, Nemoto K, Booka E, Matsubara H, Miyazaki T, Muto M, Yanagisawa A, Yoshida M (2019) Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus 16:25–43

    Article  Google Scholar 

  8. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  9. Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Oxford

    Google Scholar 

  10. Kajiyama Y, Tsurumaru M, Udagawa H, Tsutsumi K, Kinoshita Y, Ueno M, Akiyama H (1997) Prognostic factors in adenocarcinoma of the gastric cardia: pathologic stage analysis and multivariate regression analysis. J Clin Oncol 15:2015–2021

    Article  CAS  Google Scholar 

  11. Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630

    Article  Google Scholar 

  12. Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e29

    Article  Google Scholar 

  13. Suh Y, Lee JH, Jeon H, Kim D, Kim W (2012) Late onset iatrogenic diaphragmatic hernia after laparoscopy-assisted total gastrectomy for gastric cancer. J Gastric Cancer 12:49–52

    Article  Google Scholar 

  14. Murata S, Yamazaki M, Kosugi C, Hirano A, Yoshimura Y, Shiragami R, Suzuki M, Shuto K, Koda K (2014) Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction. Hernia 18:889–891

    Article  CAS  Google Scholar 

  15. Santos Bdo N, de Oliveira MB, Peixoto RD (2016) Hiatal hernia as a total gastrectomy complication. Case Rep Oncol 9:100–105

    Article  Google Scholar 

  16. Tashiro Y, Murakami M, Otsuka K, Saito K, Saito A, Motegi K, Date H, Yamashita T, Ariyoshi T, Goto S, Yamazaki K, Fujimori A, Watanabe M, Aoki T (2016) Intrathoracic hernia after total gastrectomy. Case Rep Gastroenterol 10:1–6

    Article  Google Scholar 

  17. Wang NY, Tsai CY, Liu YY, Chen IS, Ho KH (2019) Incarcerated hiatal hernia with perforation after laparoscopic total gastrectomy with Roux-en-Y reconstruction: a case report. J Gastric Cancer 19:132–137

    Article  Google Scholar 

  18. Ito E, Ohdaira H, Nakashima K, Suzuki N, Imakita T, Tsutsui N, Yoshida M, Kitajima M, Suzuki Y (2017) Crus incision without repair is a risk factor for esophageal hiatal hernia after laparoscopic total gastrectomy: a retrospective cohort study. Surg Endosc 31:237–244

    Article  Google Scholar 

  19. Gong CS, Ko CS, Kim BS, Kim HS (2019) Diaphragmatic hernia after totally laparoscopic total gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech 29:194–199

    Article  Google Scholar 

  20. Matthews J, Bhanderi S, Mitchell H, Whiting J, Vohra R, Hodson J, Griffiths E (2016) Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques? : Post-operative diaphragmatic hernias. Surg Endosc 30:5419–5427

    Article  Google Scholar 

  21. Andreou A, Pesthy S, Struecker B, Dadras M, Raakow J, Knitter S, Duwe G, Sauer IM, Beierle AS, Denecke C, Chopra S, Pratschke J, Biebl M (2017) Incidence and risk factors of symptomatic hiatal hernia following resection for gastric and esophageal cancer. Anticancer Res 37:7031–7036

    PubMed  Google Scholar 

  22. Yoshikawa K, Shimada M, Kurita N, Sato H, Iwata T, Higashijima J, Chikakiyo M, Nishi M, Kashihara H, Takasu C, Matsumoto N, Eto S (2014) Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Surg Endosc 28:1774–1778

    Article  Google Scholar 

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Funding

No specific grants were received from funding agencies in the public, commercial, or not-for-profit sectors for this research.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan

    Masayuki Urabe, Shusuke Haruta, Yu Ohkura, Akikazu Yago, Shuhei Koga, Tsuyoshi Tanaka, Masaki Ueno & Harushi Udagawa

Authors
  1. Masayuki Urabe
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  2. Shusuke Haruta
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  3. Yu Ohkura
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  4. Akikazu Yago
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  5. Shuhei Koga
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  6. Tsuyoshi Tanaka
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  7. Masaki Ueno
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  8. Harushi Udagawa
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Contributions

M. Urabe and S. Haruta participated in study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript; Y. Ohkura participated in acquisition data, analysis and interpretation of data, and drafting of manuscript; and M. Ueno and H. Udagawa participated in acquisition of data, drafting of manuscript, and critical revision of manuscript.

Corresponding author

Correspondence to Masayuki Urabe.

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Disclosures of ethical statements

The institutional review board of Toranomon Hospital approved the research protocol.

Conflict of interest

The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Urabe, M., Haruta, S., Ohkura, Y. et al. Diaphragmatic herniation following total gastrectomy: review of the long-term experience of a tertiary institution . Langenbecks Arch Surg 404, 993–998 (2019). https://doi.org/10.1007/s00423-019-01842-6

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  • DOI: https://doi.org/10.1007/s00423-019-01842-6

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