Robot-Assisted Laparoscopic Repair of a Giant Paraesophageal Hernia

Mario A Masrur, MD, Gianmarco Contino, MD, Luca Milone, MD, Eduardo Fernandes, MD, Enrique F Elli

Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.

Paraesophageal hernia repair is one of the most challenging procedures in minimally invasive surgery, mostly due to the small space for peri-esophageal dissection. The robotic approach may benefit in the mediastinal dissection and anatomical reconstruction. We present a video of a robot-assisted repair of a paraesophageal hernia reinforcing the hiatus with a matrix biological mesh.

A 72 year old man with a long lasting gastroesophageal reflux and giant paraesophageal hernia underwent robotic-assisted repair of a paraesophageal hernia with a biological mesh.

The pneumoperitoneum was achieved and a diagnostic laparoscopy was performed showing a large hernia with almost 70% of the stomach entrapped and slipped into the chest. Once the stomach and the distal esophagus were completely mobilized, closure of the crus was done with interrupted stitches and reinforced with a matrix biological mesh. A Nissen fundoplication was later performed tutored with a 56 Fr bougie. During the procedure an endoscopy was performed to identify the anatomy and indemnity of esophagus and stomach after dissection. The operative time was 220 minutes and blood loss minimal. There was no peri-operative complication and patient was discharged on PO day 2.

This video highlights the technical details and issues performing a robotic paraesophageal hernia repair. The robotic system allows for fine disecction and challenging sutures in a narrow space as the mediastinum. The robot may reduce complications such as esophageal perforation, pleural or vascular injury.

Session: Video Channel Day 1

Program Number: V045

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