Which procedure is associated with a risk of gastric perforation?

Esophagectomy is a surgical procedure involving the removal of all or part of the esophagus, which can indeed be associated with complications such as gastric perforation. During the procedure, the manipulation of the stomach and esophagus can lead to complications like a perforation if there is excessive tension or trauma to the gastric tissue. The risk is particularly notable if there are existing conditions affecting the gastric wall or surrounding structures, as well as if the surgeon is attempting to preserve as much surrounding tissue as possible.

In contrast, other procedures listed do not carry the same risk of gastric perforation. An appendectomy involves the removal of the appendix, usually resulting in minimal risk to the stomach. Cholecystectomy pertains to the gallbladder's removal, and while there can be complications associated with the nearby structures, it does not typically involve the stomach's direct manipulation that could lead to perforation. Herniorrhaphy focuses on repairing a hernia and generally does not involve any risks of gastric perforation either, as it targets the muscles and tissues of the abdominal wall rather than the gastrointestinal tract.

Thus, esophagectomy stands out as the procedure with a higher associated risk of gastric perforation due to the nature and complexity of the surgery involved.