Diaphragmatic transposition of intestinal organs is a major complication after esophagectomy and can be associated with significant morbidity and mortality. This study aims of to analyze a large series of patients with this condition in a single high-volume center for esophageal surgery and to suggest a novel treatment algorithm. Patients who received surgery for postesophagectomy diaphragmatic herniation between October 2003 and December 2017 were included. Retrospective analysis of demographic, clinical and surgical data was performed. Outcomes of measure were initial clinical presentation, postoperative complications, in-hospital mortality and herniation recurrence. A total of 39 patients who had surgery for postesophagectomy diaphragmatic herniation were identified. Diaphragmatic herniation occurred after a median time of 259 days following esophagectomy with the highest prevalence between 1 and 12 months. A total of 84.6% of the patients had neoadjuvant radiochemotherapy prior to esophagectomy. The predominantly effected organ was the transverse colon (87.2%) prolapsing into the left hemithorax (81.6%). A total of 20 patients required emergency surgery. Surgery always consisted of reposition of the intestinal organs and closure of the hiatal orifice; a laparoscopic approach was used in 25.6%. Major complications (Dindo-Clavien ≥ IIIb) were observed in 35.9%, hospital mortality rate was 7.7%. Three patients developed recurrent diaphragmatic herniation during follow-up. Postesophagectomy diaphragmatic herniation is a functional complication of the late postoperative course and predominantly occurs in patients with locally advanced adenocarcinoma having chemoradiation before Ivor-Lewis esophagectomy. Due to a high rate of emergency surgery with life-threatening complications not a 'wait-and-see' strategy but early surgical repair may be indicated.

中文翻译：

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经胸食管切除术后经肌疝：一个被低估的问题。

肠器官的after骨移位是食管切除术后的主要并发症，并可能与明显的发病率和死亡率相关。这项研究的目的是在一个大批量食管手术中心分析大量患有这种情况的患者，并提出一种新颖的治疗方法。纳入2003年10月至2017年12月间接受食管切除术后diaphragm疝手术的患者。人口，临床和手术数据进行了回顾性分析。测量的结果是最初的临床表现，术后并发症，院内死亡率和疝复发。总共鉴定出39例接受食管切除术后diaphragm肌突出手术的患者。食管切除术后中位时间259天后发生occurred骨疝，其患病率最高为1到12个月。共有84.6％的患者在食管切除术之前接受了新辅助放化疗。主要受影响的器官是横结肠（87.2％），伸入左半胸腔（81.6％）。共有20名患者需要紧急手术。外科手术通常包括重新安置肠器官和关闭裂孔。腹腔镜手术的比例为25.6％。观察到主要并发症（Dindo-Clavien≥IIIb）为35.9％，医院死亡率为7.7％。三例患者在随访过程中复发性diaphragm肌疝。食管切除术后diaphragm肌疝是术后晚期的功能性并发症，主要发生在接受Ivor-Lewis食管切除术放化疗的局部晚期腺癌患者中。由于急诊手术的高危及危及生命的并发症，因此不建议采取“观望”策略，而应尽早进行手术修复。