Summary Objective Diaphragmatic herniation is a rare complication following esophagectomy, associated with risks of aspiration pneumonia, bowel obstruction, and strangulation. Repair can be challenging due to the presence of the gastric conduit. We performed this systematic review and meta-analysis to determine the incidence and risk factors associated with diaphragmatic herniation following esophagectomy, the timing and mode of presentation, and outcomes of repair. Methods A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed using four major databases. A meta-analysis of diaphragmatic herniation incidence following esophagectomies with a minimally invasive abdominal (MIA) approach compared with open esophagectomies was conducted. Qualitative analysis was performed for tumor location, associated symptoms, time to presentation, and outcomes of postdiaphragmatic herniation repair. Results This systematic review consisted of 17,052 patients from 32 studies. The risk of diaphragmatic herniation was 2.74 times higher in MIA esophagectomy compared with open esophagectomy, with pooled incidence of 6.0% versus 3.2%, respectively. Diaphragmatic herniation was more commonly seen following surgery for distal esophageal tumors. Majority of patients (64%) were symptomatic at diagnosis. Presentation within 30 days of operation occurred in 21% of cases and is twice as likely to require emergent repair with increased surgical morbidity. Early diaphragmatic herniation recurrence and cardiorespiratory complications are common sequelae following hernia repair. Conclusions In the era of MIA esophagectomy, one has to be cognizant of the increased risk of diaphragmatic herniation and its sequelae. Failure to recognize early diaphragmatic herniation can result in catastrophic consequences. Increased vigilance and decreased threshold for imaging during this period is warranted.

中文翻译：

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微创腹部入路食管切除术后膈疝风险增加

摘要目的膈疝是食管切除术后罕见的并发症，与吸入性肺炎、肠梗阻和绞窄的风险相关。由于胃导管的存在，修复可能具有挑战性。我们进行了这项系统评价和荟萃分析，以确定食管切除术后膈疝的发生率和危险因素、就诊时间和方式以及修复结果。方法 使用四个主要数据库对系统评价和荟萃分析指南的首选报告项目进行系统搜索。与开放式食管切除术相比，采用微创腹部 (MIA) 方法进行食管切除术后膈疝发生率的荟萃分析。对肿瘤位置进行定性分析，膈疝修补的相关症状、出现时间和结果。结果 本系统评价包括来自 32 项研究的 17,052 名患者。与开放式食管切除术相比，MIA 食管切除术的膈疝风险高出 2.74 倍，合并发生率分别为 6.0% 和 3.2%。膈疝更常见于食管远端肿瘤手术后。大多数患者（64%）在诊断时有症状。21% 的病例在手术后 30 天内就诊，需要紧急修复的可能性是手术发病率增加的两倍。早期膈疝复发和心肺并发症是疝修补术后常见的后遗症。结论 在 MIA 食管切除术时代，必须认识到膈疝及其后遗症的风险增加。未能识别早期膈疝可能导致灾难性后果。在此期间提高警惕并降低成像阈值是必要的。