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Introduction: Minimally invasive esophagectomy (MIE) has evolved as a means to minimize the morbidity of an operation which is traditionally associated with significant morbidity and mortality. Given recent reports of increased hiatal herniation after robot assisted esophagectomy, we intended to describe the incidence and outcomes of hiatal hernia in a large cohort of post-MIE patients.

Methods: Clinical follow up data on one hundred and fourteen patients who had undergone minimally invasive esophagectomy between 2000 and 2011 was retrospectively reviewed. Imaging findings derived from routine computed tomography (CT) scans of the chest and abdomen were used to establish the diagnosis of hiatal herniation after minimally invasive esophagectomy. Age, gender, comorbid conditions, clinical tumor stage, specimen size, length and cost of hospital admissions, presenting complaint for hiatal hernia, operation performed to correct hiatal herniation, and mortality were all recorded for analysis.

Results: Of the 114 patients identified in the database who underwent MIE, a total of 8 were identified with postoperative hiatal herniation (7% incidence). Five of these patients were asymptomatic. One of the three symptomatic patients presented with a perforated colon in the chest. One patient complained of abdominal pain, nausea and vomiting, and a final patient complained of gastric outlet obstruction with chest and neck fullness. All patients except the one who presented emergently were repaired laparoscopically on an elective basis. The average length of stay associated with hiatal hernia repair in this setting was 5 days at an average expense of \,785 (range \,264-\,953). At follow-up only 1 patient complained of symptoms associated with reflux.

Conclusion: Hiatal herniation is not a rare event after MIE. It is also associated with a large health care cost and may be lethal. Most occurrences appear to be asymptomatic and if detected, can be repaired with good resolution of symptoms and minimal associated morbidity.