A Bernshteyn, I Fendrich, S Szomstein, R J Rosenthal. Cleveland Clinic Florida
Background: Esophageal strictures after repair of hiatal hernias with mesh are a rare but devastating complication. We present the case of a patient that developed a mesh erosion and distal esophageal stricture requiring laparoscopic resection of the GE junction
Methods: A 70 year old female presented after repair of hiatal hernia with Nissen Fundoplication complained of progressive dysphagia. Multiple EGDs demonstrated a benign stricture which failed dilatation and persisted despite placement of an esophageal stent. The patient underwent a laparoscopic re-exploration. Intraoperatively, multiple adhesions where taken down and a circumferentially placed mesh was excised. During the excision of the eroded mesh, the distal esophagus was entered. The GE junction was then excised and an esophagogastrostomy in a latero lateral fashion using a linear stapler was performed. Pyloroplasty for drainage and tube jejunostomy for early feeding was carried out. Drains where placed into the left and right subhepatic positions to allow for wide drainage.
Result: The postoperative period was remarkable for a slow return of GI function. Upper GI swallow was performed on day 8 and the patient was started on a clear liquid diet while continuing with tube feeds. Patient was discharged on post operative day 14 on liquid diet and with nightly jejunostomy feeding. One month post discharge the patient had complete resolution of symptoms and was tolerating a regular diet.
Conclusion: Laparoscopic treatment for lower esophageal stricture post circumferential biologic mesh with erosion appears to be a safe and feasible approach.
Program Number: V018