Amanda B Sosulski, MD1, Sathyaprasad Burjonrappa, MD, FACS2, Charles V Coren, MD, FACS1, Collin Brathwaite, MD, FACS2. 1NYU Winthrop, Stony Brook Medicine, 2NYU Winthrop
INTRODUCTION: Paraesophageal hiatal hernia (PHH), is an uncommon entity in infants with variable clinical presentation and symptomatology. Patients can be completely asymptomatic or more commonly have feeding difficulties or respiratory issues, rarely presenting with dramatic complications of ischemia or volvulus. Work up typically involves plain X-ray and a contrast radiological study. For adult patients, the standard of care is through a minimally invasive, laparoscopic approach. In infants and children, a best approach for repair is not well established as thoracic, abdominal and thoracoabdominal approaches have all been employed with satisfactory results. Due to risk of complications, surgical repair is necessary shortly after diagnosis and includes hernia reduction as well as an anti-reflux procedure. We present a case of a laparoscopic repair of a PHH in a 13 month old infant.
CASE REPORT: A 10 month old infant was seen in the ER with 2 week history of diarrhea, bloody stool and vomiting. He had been treated for milk protein allergy 1 month prior, but had been thriving and growing well for the first 9 months of life. Radiographs revealed large PHH upon work up in the emergency department. GI consultation and barium esophagram were obtained and confirmed the presence of herniation. Elective repair was scheduled. Successful laparoscopic repair with gastrostomy tube placement was performed. Postoperative imaging confirmed an adequate repair, and post-operative course was uneventful, with the patient tolerating oral feeds and an age appropriate diet as expected. The patient had improved oral intake and feeding behaviors as per his mother, and the gastrostomy tube, which was never used for feeding was removed one month postoperatively.
CONCLUSION: Laparoscopic techniques are safe and well tolerated for repair in infants with paraesophageal hiatal hernia. As in adults, the key aspect of performing repair is complete reduction and excision of the hernia sac.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87478
Program Number: V099
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo
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