{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:46:56Z","timestamp":1768974416225,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T00:00:00Z","timestamp":1685491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Clinical Study Support Center at Wakayama Medical University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,27]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Diaphragmatic hernia is a very rare but high-risk complication after esophagectomy. Although there are many studies on the Ivor Lewis esophagectomy procedure for diaphragmatic hernia, there are fewer studies on the McKeown procedure. The present study aimed to estimate the incidence of diaphragmatic hernia after esophagectomy, describing its presentation and management with the McKeown procedure. We retrospectively evaluated the 622 patients who underwent radical esophagectomy between January 2002 and December 2020 at the Wakayama Medical University Hospital. Statistical analyses were performed to evaluate risk factors for diaphragmatic hernia. Emergency surgery for postoperative diaphragmatic hernia was performed in nine of 622 patients (1.45%). Of these nine patients, one developed prolapse of the small intestine into the mediastinum (11.1%). The other eight patients underwent posterior mediastinal route reconstructions (88.9%), one of whom developed prolapse of the gastric conduit, and seven of whom developed transverse colon via the diaphragmatic hiatus. Laparoscopic surgery was identified in multivariate analysis as the only independent risk factor for diaphragmatic hernia (odd\u2019s ratio [OR]\u2009=\u20099.802, p\u2009=\u20090.034). In all seven cases of transverse colon prolapse into the thoracic cavity, the prolapsed organ had herniated from the left anterior part of gastric conduit. Laparoscopic surgery for esophageal cancer is a risk factor for diaphragmatic hernia. The left anterior surface of gastric conduit and diaphragmatic hiatus should be fixed firmly without compromising blood flow to the gastric conduit.<\/jats:p>","DOI":"10.1093\/dote\/doad037","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T07:01:30Z","timestamp":1685602890000},"source":"Crossref","is-referenced-by-count":4,"title":["Laparoscopic reconstruction in McKeown esophagectomy is a risk factor for postoperative diaphragmatic hernia"],"prefix":"10.1093","volume":"36","author":[{"given":"Akihiro","family":"Takeuchi","sequence":"first","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4958-9525","authenticated-orcid":false,"given":"Toshiyasu","family":"Ojima","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiji","family":"Hayata","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Kitadani","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taro","family":"Goda","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinta","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoki","family":"Nakai","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Yamaue","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Kawai","sequence":"additional","affiliation":[{"name":"Second Department of Surgery , School of Medicine, , Wakayama 641-0045 , Japan"},{"name":"Wakayama Medical University , School of Medicine, , Wakayama 641-0045 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,5,31]]},"reference":[{"key":"2023102807345225100_ref1","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1001\/jamaoncol.2019.2996","article-title":"Global, regional, and National Cancer Incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study","volume":"5","author":"Global Burden of Disease Cancer Collaboration","year":"2019","journal-title":"JAMA Oncol"},{"key":"2023102807345225100_ref2","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/S1470-2045(03)01167-7","article-title":"The role of surgery in the management of oesophageal cancer","volume":"4","author":"Wu","year":"2003","journal-title":"Lancet 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esophagus: a meta-analysis of randomized trials","volume":"18","author":"Kumar","year":"2020","journal-title":"World J Surg Oncol"},{"key":"2023102807345225100_ref6","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1186\/s12957-021-02446-5","article-title":"Neoadjuvant camrelizumab plus chemotherapy in treating locally advanced esophageal squamous cell carcinoma patients: a pilot study","volume":"19","author":"Yang","year":"2021","journal-title":"World J Surg Oncol"},{"key":"2023102807345225100_ref7","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s10388-018-0617-9","article-title":"Recent progress in perioperative management of patients undergoing esophagectomy for esophageal cancer","volume":"15","author":"Watanabe","year":"2018","journal-title":"Esophagus"},{"key":"2023102807345225100_ref8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/SLA.0000000000000644","article-title":"A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database","volume":"260","author":"Takeuchi","year":"2014","journal-title":"Ann Surg"},{"key":"2023102807345225100_ref9","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1002\/bjs.10548","article-title":"Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer","volume":"104","author":"Ojima","year":"2017","journal-title":"Br J Surg"},{"key":"2023102807345225100_ref10","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1016\/j.athoracsur.2007.07.009","article-title":"Diaphragmatic hernia after conventional or laparoscopic-assisted transthoracic esophagectomy","volume":"84","author":"Vallb\u00f6hmer","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2023102807345225100_ref11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/doaa024","article-title":"Transdiaphragmatic herniation after transthoracic esophagectomy: an underestimated problem","volume":"33","author":"Fuchs","year":"2020","journal-title":"Dis Esophagus"},{"key":"2023102807345225100_ref12","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1007\/s00423-021-02214-9","article-title":"Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis","volume":"406","author":"Bona","year":"2021","journal-title":"Langenbecks Arch Surg"},{"key":"2023102807345225100_ref13","doi-asserted-by":"crossref","first-page":"160","DOI":"10.21037\/jtd-20-1974","article-title":"Diaphragmatic hernia after Ivor Lewis esophagectomy for cancer: a retrospective analysis of risk factors and post-repair outcomes","volume":"13","author":"Puccetti","year":"2021","journal-title":"J Thorac Dis"},{"key":"2023102807345225100_ref14","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1002\/bjs.1800630403","article-title":"Total three-stage oesophagectomy for cancer of the oesophagus","volume":"63","author":"McKeown","year":"1976","journal-title":"Br J Surg"},{"key":"2023102807345225100_ref15","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/bjs.18003413304","article-title":"The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third","volume":"34","author":"Lewis","year":"1946","journal-title":"Br J Surg"},{"key":"2023102807345225100_ref16","volume-title":"TNM Classification of Malignant Tumors","author":"Union for International Cancer Control","year":"2017","edition":"Eight"},{"key":"2023102807345225100_ref17","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/S0140-6736(12)60516-9","article-title":"Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled 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following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy","volume":"16","author":"Willer","year":"2012","journal-title":"Hernia"},{"key":"2023102807345225100_ref24","doi-asserted-by":"crossref","first-page":"4661","DOI":"10.21037\/jtd-20-1335","article-title":"Postoperative hiatal hernia after minimally invasive esophagectomy for esophageal cancer","volume":"12","author":"Iwasaki","year":"2020","journal-title":"J Thorac Dis"},{"key":"2023102807345225100_ref25","doi-asserted-by":"crossref","first-page":"106046","DOI":"10.1016\/j.ijsu.2021.106046","article-title":"Postoperative hiatal herniation after open vs. minimally invasive esophagectomy; a systematic review and meta-analysis","volume":"93","author":"Murad","year":"2021","journal-title":"Int J Surg"},{"key":"2023102807345225100_ref26","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1007\/s11695-007-9260-6","article-title":"Trends in internal hernia incidence after laparoscopic roux-en-Y gastric bypass","volume":"17","author":"Ahmed","year":"2007","journal-title":"Obes Surg"},{"key":"2023102807345225100_ref27","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s10388-015-0485-5","article-title":"Diaphragmatic herniation after thoracolaparoscopic esophagectomy for carcinoma of the esophagus: a report of six cases","volume":"13","author":"Kanamori","year":"2016","journal-title":"Esophagus"},{"key":"2023102807345225100_ref28","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1016\/j.athoracsur.2011.08.013","article-title":"Hiatal hernia after Esophagectomy: analysis of 2,182 Esophagectomies from a single institution","volume":"92","author":"Price","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2023102807345225100_ref29","first-page":"259","article-title":"Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency","author":"Oppelt","year":"2022"},{"key":"2023102807345225100_ref30","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1093\/ejcts\/ezy451","article-title":"Hiatal hernia after oesophagectomy: a large European survey","volume":"55","author":"Gusta","year":"2019","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/36\/11\/doad037\/52632414\/doad037.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/36\/11\/doad037\/52632414\/doad037.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T07:35:17Z","timestamp":1698478517000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doad037\/7187105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,31]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,5,31]]},"published-print":{"date-parts":[[2023,10,27]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doad037","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11]]},"published":{"date-parts":[[2023,5,31]]},"article-number":"doad037"}}