Evelyn Dorado, md, Jessica Correa. FUNDACION VALLE DEL LILI
INTRODUCTION: Paraesophageal type Iv hiatal hernia after three field minimally invasive esophagectomy is a rare complication, the incidence is 0,8% and is related with wide disecction of the hiatus before rise the stomach into the thorax. damage control had been describe for trauma with good results, some articules described damage control in peritonitis but use it in no trauma or peritonitis patient and by laparoscopy is new.
MAIN: demonstrate the effectiveness of laparoscopic damage control in nont raumatic pathology or peritonitis
METHODS AND RESULT: 65 y/o female patient with antecedent of left thoracotony Heller Miotomy 20 years ago and radiologic findings of megaesophagus and severe regurgitation. I operated this patient in february: Three fields minimally invasive esophagectomy in prone,9 moths later the patient feel abdominal pain and dysnea, the CTSCAN report bowel into the left thorax and lung collapse. the patient was intubated and transferred to ICU.
I schedualed for laparoscopy, surgical findings were double loop incarceration into the hiatus with bowel necrosis. I reduced the content open the hiatus with scissors and close the defect. as soon as reduced the hernia , the patient turned inestable, MAP <50 requiered high dosis of epinephrine and metabolic acidosis, we decided make a damage control, ligate the bowel and stabilize the patient. 30 hours later without acidosis, low doses of norepinephrine returned for laparoscopic second look and anastomosis. 24 extubated, no vasopresor, 72 hours oral intake and 5 days later return to her home.
CONCLUSION: Damage control has been demonstrated in trauma surgery be an effective tool to reduce morbidity and mortality. use in laparoscopy and nontraumatic pathologies has not been reported but are also provided satisfactory results in addition to the benefits of minimally invasive surgery in the recovery of the patient.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78588
Program Number: P402
Presentation Session: Poster (Non CME)
Presentation Type: Poster
