Morgan M Bonds, MD, Subrato Deb, MD. University of Oklahoma Health Science Center
Introduction: Esophagectomy is a common treatment for both benign and malignant pathologies of the foregut. Hiatial paraconduit hernias are rare complications following esophagectomy. In this study, we review our experience with these rare diaphragmatic hernias.
Methods: A retrospective analysis of all patients presenting with hiatial hernia after esophageal resection at the University of Oklahoma Health Science Center between 2014 and 2017 was performed. Data was abstracted from the medical record for evaluation and included demographics, symptoms, repair techniques and outcomes. No patients were excluded.
Results: A total of ten patients were identified to have paraconduit hernias. During this time interval, there were a total of 130 esophageal resections performed. All patients had esophagectomy for malignant disease. Seven of the 10 patients have undergone surgery. Two patients are asymptomatic and are being followed at their request, and one patient is pending elective correction. Of the seven patients who underwent surgery, the median age was 58, with 5 males and two females. Six of the seven patients underwent minimally invasive Ivor Lewis esophagectomy and one had an open McKeown procedure. The median time from esophagectomy to hernia repair was 12 months, with range from 1 month to 120 months. The most common presenting complaint was abdominal pain and nausea. One patient was noted to have a paraconduit hernia on postoperative day 5 and taken to surgery for repair during the hospitalization. There was one death in a patient who presented with necrosis of the small bowel. The remaining 6 patients all had laparoscopic approach. One patient required a hand port to reduce incarcerated colon and one patient was noted to have a cecal perforation during port closure requiring repair. All patients had herniated colon, with small intestine or pancreas herniation noted in three. Repair was performed by reducing the viscera, a left phrenic relaxing incision, closure of the hiatus around the conduit and then closure of the diaphragmatic defect with mesh. At median follow up of 6 months, there are no recurrences.
Conclusion: Hiatal paraconduit hernias are becoming a frequent finding among survivors of esophageal cancer surgery. Our study demonstrates that there is a propensity for patients who undergo minimally invasive esophagectomy to develop these hernias. The vast majority of patients can undergo laparoscopic repair. Our recommendation is to perform a diaphragmatic relaxing incision and liberal use of mesh. Early results appear to be favorable regarding recurrence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86542
Program Number: P412
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster