Ahmed Sharata, MD1, Christy Dunst, MD1, Marc Ward, MD2, Ezra Teitelbaum, MD2, Kevin Reavis, MD1, Steven DeMeester, MD1, Lee Swanstrom, MD1. 1Oregon Clinic/GMIS, 2Portland Providence Cancer Center
Background: Paraesophageal hernia recurrence is relatively high reach up to 50% after 5 years of the primary repair. While asymptomatic recurrence can be safely observed, surgery is indicated in the symptomatic recurrence. However the therapeutic approach still controversial especially when its associated with strangulation or perforation of the herniated wrap. Our objective is to illustrate a safe and durable surgical option in the treatment of patients with perforated recurrent paraesophageal hernia while preserving the wrap for secondary fundoplication repair.
Methods: After placing five trocars in the usual position for a foregut laparoscopic surgery, a lysis of adhesions and standard dissection of the hiatus is performed. Herniated wrap was reduced and revision of the primary fundoplication performed carefully to localize the perforation. Once the perforation recognized, posterior wall of the gastric fundus, wedge gastrectomy performed using 2 staplers to repair the perforation while reserving the fundus for redo fundoplication. A transhiatal decortication of the mediastinum was done as shown in the video. A releasing mesh incision of the right and left cruse was performed so secondary anterior and posterior crural tension free closure achieved. The reserved gastric fundus after perforation repair was used for redoes fundoplication.
CONCLUSION: The perforated recurrent paraesophageal hernia repair is challenging procedure. A fundus reserving approach is a valid and safe treatment of perforated recurrent paraesophageal hernia patients. The key to successful treatment is conservative perforation closure approach and tension free hiatal repair. This also represents a safe and durable tension free hiatal closure in this uniquely challenging patient population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80420
Program Number: V007
Presentation Session: Foregut 1
Presentation Type: Video
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