Post Esophagectomy Diaphragmatic Hernia (PEDH): An Experience of a Dedicated Cancer Center of Pakistan

Objective: To study the outcomes of post esophagectomy diaphragmatic hernia managed at our institute. Methodology: We conducted a retrospective case series among patients who underwent surgical resection for esophageal cancer in the last 10 years from Jan 2010 to Dec 2019. Patient’s charts were reviewed and postoperative surveillance CT scans were reviewed for the development of post-operative diaphragmatic hernias. Demographic and variables related to diaphragmatic hernia and its management were recorded and analysed. Results: Out of 590 patients, 10 patients developed post esophagectomy diaphragmatic hernia. All patients received neo adjuvant chemo-radiotherapy. 8 patients underwent three stage esophagectomy, one had Ivor Lewis esophagectomy and one had transhiatal esophagectomy. CT scan was used as a modality of choice for the diagnosis. Two patients developed hernia during their hospital stay and 8 patients presented late. 7 patients were diagnosed due to complications of the hernia. One patient presented with acute abdomen and ischaemic gut. 2 presented with severe epigastric pain. 4 presented with shortness of breath. 3 patients were diagnosed on surveillance CT scans. All patients underwent surgery for closure of the hernia defect. Laparoscopic surgical management was performed in 5 patients. Five patients had primary tension free closure while five patients had mesh repair. Two patients had recurrence. Both were re-operated and mesh repair was done. There was no 30 days mortality. Conclusion: Diaphragmatic hernia is a serious complication. Early surgical intervention is needed for the treatment. With minimally invasive techniques, incidence has increased. For standardization of management and quality of care, randomized control trials are needed.