Laparoscopic Repair of Hiatal Hernia, an Early Postoperative Complication in Esophageal Cancer Surgery—A Case Report—

Abstract

A 62-year-old man presented with dysphagia, and was suspected to have esophageal cancer on upper gastrointestinal endoscopy. The patient was diagnosed with cStage III esophageal squamous cell carcinoma in the abdominal esophagus (cT3N1M0). Treatment before surgery included 2 rounds of chemotherapy (5-fluorouracil and cisplatin) and 20 rounds of radiotherapy (40 Gy), and resulted in a partial response. Aiming at curative excision, we performed subtotal esophagectomy, posterior mediastinal reconstruction of the gastric tube, three-field lymphadenectomy, and an enterostomy. Seven days after the surgery, chest radiography and computed tomography showed intestinal gas in the left thoracic cavity, and an asymptomatic hiatal hernia was diagnosed. Because the intestinal tract significantly bulged into the left thoracic cavity through the esophageal hiatus, we performed laparoscopic repair as a second surgery. The herniated transverse colon was reduced and the esophageal hiatus was sutured and repaired with a sheet of mesh. The patient recovered well and was discharged twenty days after the first surgery.