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Ann Thorac Surg 2008;86:975-983. doi:10.1016/j.athoracsur.2008.04.098
© 2008 The Society of Thoracic Surgeons
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Michael S. Kent
James D. Luketich
Rodney Landreneau
Miguel Alvelo-Rivera
Matthew Schuchert
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Original Articles: General Thoracic

Revisional Surgery After Esophagectomy: An Analysis of 43 Patients

Michael S. Kent, MD, James D. Luketich, MD*, Wilson Tsai, MD, Patricia Churilla, RN, Michael Federle, MD, Rodney Landreneau, MD, Miguel Alvelo-Rivera, MD, Matthew Schuchert, MD

Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Accepted for publication April 28, 2008.

* Address correspondence to Dr Luketich, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15232 (Email: luketichjd{at}upmc.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Reflux and postprandial fullness are common after esophagectomy. On occasion, these symptoms have an anatomic basis that requires operative correction. Two such conditions are the following: (1) a diaphragmatic hernia in which bowel herniates into the chest; and (2) a redundant conduit that impairs gastric emptying. The recognition of these conditions and the results of operative correction are the subject of this analysis.

Methods: A retrospective review from 1995 to 2007 identified patients who developed either a diaphragmatic hernia or a redundant gastric conduit after esophagectomy. The presenting symptoms, operative approach, and outcomes after surgery were recorded.

Results: Forty-three patients (representing 4% of the esophagectomy volume in this time period) were identified with a diaphragmatic hernia (n = 21), redundant gastric conduit (n = 19), or both (n = 3). Mean time from esophagectomy to diagnosis was 32 months for diaphragmatic hernia and 18 months for redundant conduit. The majority of hernias occurred to the left of the gastric conduit. A mechanical obstruction to gastric emptying was noted in 54% of patients with a redundant conduit. Forty patients underwent revisional surgery (minimally invasive: 35; open: 5). The recurrence rate after repair of a diaphragmatic hernia was 29%. Symptoms improved in 85% of patients after revision of a redundant conduit.

Conclusions: A diaphragmatic hernia or redundant conduit may occur years after esophagectomy. Hernias almost always occur adjacent to the greater curve of the stomach. The development of a redundant conduit may be associated with a functional outflow obstruction. Surgical correction of these conditions can alleviate symptoms in the majority of patients.






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