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ROBOTIC-ASSISTED RECURRENT PARAESOPHAGEAL HERNIA REPAIR WITH MESH AND NISSEN FUNDOPLICATION.

Enrique F Elli, MD, FACS, Tamara Diaz Vico, MD. Mayo Clinic Florida

We report a 25 years-old patient, with history of GERD and previous paraesophageal hernia repair with a biological mesh in 2012. The patient came to our clinic complaining of dysphagia and postprandial epigastric pain. Preoperative studies were performed, including a fluoroscopic contrast study that showed a recurrence of the paraesophageal hernia. Patient was selected to undergo a robotic repair of the recurrence. 

Two 12-mm and three 5-mm robotic trocars were placed in a wide “v”. The procedure started with a diagnostic laparoscopy, showing hiatal herniation and tackers placed over the previous biological mesh. Using monopolar hook, right crus was dissected. The stitches from previous cruroplasty were also seen and cut. The tackers were removed from the hiatus, and also from the posterior side of the esophagus. Dissection was carried out posterior to the esophagus, and continued around the left crus.Through a posterior window, a Penrose drain was placed around the esophagus for retraction and exposure. Once the dissection in the mediastinum was finished, the pillars were approximated with interrupted stitches of 2-0 Ethibond. An anterior interrupted stitch was placed to restored the anatomy. A biological mesh was emplaced to reinforce the hiatus. The mesh was stitched to the hiatus with multiple absorbable sutures. The robot allows for precise placement of sutures. Lastly, a Nissen fundoplication was performed using interrupted absorbable sutures. Using a robotic instrument, the wrap was checked to confirm a floppy Nissen. 

The operative room time was 135 minutes. No intraoperative complications occurred. The postoperative course was uneventful and the patient was discharge on postoperative day 1. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94609

Program Number: V313

Presentation Session: Video Loop Day 3

Presentation Type: VideoLoop

63

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