Laparoscopic Repair of Late Hiatal hernias(>2years) after Transhiatal Esophagectomy

Oscar M Crespin, M, D, Brant K Oelschlager, M, D, Carlos A Pellegrini, M, D. University of Washington Medical Center.

Introduction:

Late and symptomatic herniation after esophagectomy is an unusual complication (0.4 -5 %). Almost always occurs into the left chest. Usually involves colon and small bowel. May present with obstructive symptoms or respiratory compromise. The goals to repair are: preservation of the conduit, the reduction of the contents and the closure of the hiatal defect.

Although the reduction of the content is very straightforward, the technique to close the hiatus is debated.

Methods and objectives:

The aim of this video is to show three different cases of hiatal hernia after laparoscopic assisted esophagectomy and how we proceeded to solve it.

 

The first case is a 70 y/o symptomatic patient, 8 status post laparoscopic assisted transhiatal esophagectomy for esophageal cancer. With this case we wanted to show the first step that is the reduction of the contents.

The second case is a 65 years old, symptomatic patient 5 years status post laparoscopic assisted transhiatal esophagectomy for esophageal cancer. With this case we wanted to show how we performed the hiatal dissection.

The third case is young patient 2 years after laparoscopic assisted transhiatal esophagectomy with more acute and obstructive symptoms. With this case we wanted to show how we close the hiatus.

Conclusion:

Late hiatal hernia after transhiatal esophagectomy is a rare complication. Case reports describe this complication but the technique to close the hiatus is debated. We presented with 3 cases how we approached the closure of the hiatus with good outcomes.

 

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