Mediastinal Hematoma After 360 Degree Fundoplication: As Cause of Post-operative Dysphagia

Michele A Riordon, MD, Amanda Parker, MD, Vadim Sherman, MD, Brian J Dunkin, MD, Patrick R Reardon, MD. The Methodist Hospital

 

INTRODUCTION:
Dysphagia following 360 degree fundoplication and/or hiatal hernia repair is often attributed to surgical factors such as degree and tightness of wrap, hiatal hernia closure, and post-operative edema. To date there is no report in literature of mediastinal hematoma and resulting fibrosis as an etiology of post fundoplication dysphagia.

METHODS:
Patients were identified retrospectively in a single surgeon’s database as having laparoscopic or thoracoscopic mediastinal hematoma evacuation following 360 degree fundoplication and hiatal hernia repair for gastroesophageal reflux disease.

RESULTS:
Prior to 360 degree fundoplication all patients had symptoms and diagnostic work up consistent with gastroesophageal reflux disease, hiatal hernia, and non-specific esophageal motor dysfunction. They all underwent uncomplicated laparoscopic “loose” 360 degree fundoplication and were discharged home within 1-2 days. Two patients presented with significant dysphagia 2-3 weeks post fundoplication and one patient presented 2 months post fundoplication. All patients were worked up with esophagogastroscopy and esophagram. Two patients also had a CT scan of the chest and abdomen. All diagnostic tests were consistent with extrinsic compression of the esophagus and significant narrowing of the esophageal lumen. Intra-operatively two patients had organized hematoma in the distal mediastinum and one patient had a liquid hematoma in the mid mediastinum compressing the esophagus. Surgical evacuation of hematoma and resection of the fibrotic scar relieved dysphagia in all cases confirmed by patient symptoms and esophagram.

CONCLUSION:
Mediastinal hematoma may be a cause of post-operative dysphagia after 360 degree fundoplication and /or hiatal hernia repair. Surgeons should be aware that mediastinal hematoma and the fibrotic reaction it creates may contribute to their patients post operative dysphagia.


Session Number: VidTV3 – Video Channel Rotation Day 3
Program Number: V147

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