Evelyn Dorado, DR. Fundacion Valle Del Lili
INTRODUCTION: Minimal Invasive three-fields esophagectomy for minimal invasion is the surgical standard for oncological procedures and benign diseases. Cervical dissection has a risk of 2 to 59% in some series ,of,lesion or paralysis of the RNL, but the standard in Mckeon approach is 14%. A high level of suspicion is needed because this type of lesion has an impact on postoperative evolution and the hospital stay.
MAIN: To describe three cases of RNL post esophagectomy paralysis in three planes by least invasion.
METHODS: In a period of 3 years, january 2015 to june 2017, 10 esophagectomies for bening disease were performed. Three patients (2 males 1 female) with diagnosis of terminal achalasia and 1 stenosis secondary to caustic ingestion consulted at the minimal invasion service Fundcacion Valle del Lili. They were schedualed for minimal invasive three fields esophagectomy, one patient without complications and early discharge ( 5 postoperative day) but occasional dysphagia, the other two required early reintubation after de surgery with ARDS, 1 patient requiered tracheostomy, the second patient could be extubated after 2 days but with occasional dysphagia. All three had mild hoarseness after surgery. The patient who required tracheostomy was decannulated at 20 days without complication.
RESULTS: The three patients underwent endoscopy without complication in the cervical anastomosis stenosis or disorder in the emptying of the gastric tube, swallowing study without alteration and laryngoscopy with paralysis of the left vocal cord. These patients went to speech therapy with total paralysis recovery at 6 months corroborated with laryngoscopy, without dysphagia or hoarseness
CONCLUSION: RNL innervates the larynx and upper esophageal sphincter, therefore lesion or paresis causes symptoms such as hoarseness, dysphagia, difficulty swallowing, aspiration, difficulty in coughing, pneumonia and ARDS. Injury has a predecessor factor in pulmonary complications and prolongation of the hospital stay. 14% of these patients may require some surgical procedure to restore the function of RNL. Noninvasive monitoring of the laryngeal nerve decreases the risk of injury.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88028
Program Number: P393
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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