Case Reports
Pleural incarceration of the gastric graft after trans-hiatal esophagectomy

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Abstract

We report on a 73-year-old man who underwent a trans-hiatal esophagectomy for a T2N1M0 adenocarcinoma of the distal esophagus and developed an incarcerated herniation of the gastric graft through a defect in the right mediastinal pleura. The patient experienced delayed gastric emptying postoperatively, which was initially suggested by barium swallow. The gastric herniation was unidentified by early postoperative swallowing studies and endoscopies. After diagnosis by a later computed tomographic scan and barium study, the herniation was reduced by incising the mediastinal pleura from the diaphragm to the apex of the chest and by plication of the stomach longitudinally in order to reduce its intrathoracic diameter.

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Comment

Before the routine use of trans-hiatal esophagectomy, postoperative pneumonia and anastomotic leak were the most frequent complications of esophagectomy [3]. Trans-hiatal esophagectomy reduces the incidence of significant respiratory complications after esophagectomy. However, the incidence of anastomotic leak using this technique has not been as dramatically reduced [4]. This benefit may be theoretical, however, as one study reported a near equal incidence and mortality rate between patients

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Copyright © 1999 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.