Laparoscopic Repair of Hiatal Hernias Post-Esophagectomy

Konstantinos Spaniolas, MD, Cherie P Erkmen, MD, Thadeus L Trus, MD

DARTMOUTH-HITCHCOCK MEDICAL CENTER

INTRODUCTION: The awareness of the development of hiatal hernias in patients who have previously undergone esophagectomy has recently increased, with incidence ranging from less than one to 26%. Most published reports describe open transabdominal or transthoracic repair and are associated with high morbidity and prolonged length of stay. The objective of this study was to evaluate the short and long-term outcomes associated with the laparoscopic repair of post-esophagectomy hiatal hernia (PEHH).

METHODS AND PROCEDURES: This is a retrospective single-institution study reporting the experience with laparoscopic repair of PEHH. Demographic, diagnostic and perioperative data were collected, as well as details from follow-up assessments. Descriptive statistics were performed and results are presented as number (percentage) or median (range).

RESULTS: Four patients were identified from October 2011 to August 2012; all were male and the median age was 71 (62 – 85) years. They presented 27.5 (14 – 38) months after esophagectomy. One patient underwent minimally invasive, one Ivor-Lewis, and two patients three-hole video-assisted esophagectomy. One patient was asymptomatic but was found to have a large PEHH with more than half of his small bowel herniated in the chest. Two patients had crampy upper abdominal pain and shortness of breath, and one patient presented with symptoms of partial small bowel obstruction. This patient underwent laparoscopy which revealed carcinomatosis, and no hernia repair was undertaken. The remaining three patients underwent laparoscopic repair of PEHH, with mesh reinforcement used in two. Length of stay was 2 (1 – 3) days. Thirty-day morbidity and mortality were nil. After 6 (1 – 9) months follow up, there was no symptomatic recurrence and all patients were symptom-free.

CONCLUSIONS: Laparoscopic repair of PEHH is feasible and safe. It is a procedure associated with minimal in-hospital recovery, and in our experience, no morbidity and mortality.

Session: Poster Presentation

Program Number: P253