Resection and repair of postoperative diaphragmatic hernia with strangulated bowel obstruction after esophageal cancer via thoracic cavity: A case report.

Postoperative diaphragmatic hernia is an uncommon complication following esophagectomy for esophageal cancer. Once it occurs, emergency surgical intervention is typically required. However, the optimal surgical repair approach remains debatable depending on the specific clinical scenario. Therefore, we aim to investigate the common etiological factors and optimal surgical strategies for post-esophagectomy diaphragmatic hernia, and share our therapeutic experience to provide optimal treatment for patients. A 70-year-old male patient developed sudden chest tightness and retrosternal pain during nocturnal sleep 17 months after radical esophagectomy, accompanied by persistent pain in the left upper abdomen that prevented standing, with nausea (no vomiting), and absence of defecation or flatus. Diaphragmatic hernia, strangulated intestinal obstruction, and esophageal cancer (postoperative status). Emergency transthoracic diaphragmatic hernia repair with partial small bowel resection was performed via thoracic approach. On postoperative day 9, the patient's bowel and urinary functions returned to normal, resumed a semiliquid diet, was discharged after suture removal. Post-esophagectomy diaphragmatic hernia represents a severe complication. Open transthoracic surgery proves to be a safe and effective approach for cases complicated by strangulated intestinal obstruction. However, in cases of diaphragmatic hernia following minimally invasive esophagectomy without preoperative evidence of strangulation, laparoscopic exploration and repair could be considered. Regardless of open or minimally invasive esophagectomy, meticulous operative techniques should be employed to minimize the risk of diaphragmatic hernia formation.