Background: Intrathoracic herniation of abdominal viscera is a potentially
life-threatening condition, especially when diagnosis is delayed. The aim o
f this study was to estimate its incidence following oesophageal resection
and to define contributing factors that might influence its occurrence.
Methods: All radiographic studies of the chest that were made during follow
-up in a series of 218 patients who underwent oesophagectomy between 1993 a
nd 1997 were reviewed.
Results: Herniation of bowel alongside the oesophageal substitute was detec
ted in nine patients (4 per cent). Four hernias occurred within the first w
eek after operation and five were detected at late follow-up. Surgical trea
tment was indicated in six patients. Analysis of predisposing factors revea
led that extended incision and partial resection of the diaphragm were asso
ciated with an increased risk of postoperative hernia formation (four of 29
following extended enlargement versus five of 189 after routine opening of
the oesophageal hiatus; P = 0.02).
Conclusion: Diaphragmatic herniation was found in 4 per cent of patients af
ter oesophagectomy. After extended iatrogenic disruption of the normal hiat
al anatomy, narrowing of the diaphragmatic opening may be indicated to avoi
d postoperative herniation of bowel into the chest. Awareness of its possib
le occurrence may help prevent the development of intestinal obstruction an
d strangulation.