NOVEL COMBINED VATS/LAPAROSCOPIC APPROACH FOR GIANT AND COMPLICATED PARAESOPHAGEAL HERNIA REPAIR: DESCRIPTION OF TECHNIQUE AND EARLY RESULTS
Presented by Daniela Molena at the SAGES 2014 Meeting; Panel – Concurrent session SS2 Video 1
Daniela Molena, MD, Benedetto Mungo, MD, Miloslawa Stem, MS, Anne O Lidor, MD, MPH; Johns Hopkins Medicine
Points of interest:
CT of giant type IV PEH–15 sec
procedure begins–52 sec
thoracic exploration–55 sec
division of inferior pulmonary ligament–1:07
dissection of the hernia sac aortic side–1
Keyword(s): 52 Fr Bougie, ABD, abdominal cavity, abdominal esophagus, abdominal port placement, adequate esophageal length, AF, anterior esophageal wall, anterior gastropexy, anterior stitch, anterior vagus nerve, anteriorly, aortic arch, approximated, assessment of esophageal extensive mobilization, assistant, benefits of MIS, biological mesh, bleeding, bronchial branches, bronchus, buttress, camera, cephalad, challenging, chest, chest tube, circumferentially, clamped, clearly visible, complete release of the nerve, completely exposed, completely mobilized, complex incisional hernias, concurrent repair, contralateral pleura, conversion laparotomy, conversion thoracotomy, created, crural dissection, cruroplasty, CT, diaphragm, diaphragmatic attachments, diaphragmatic hiatus, diaphragmatic repair, dissection of the hernia sac, dissection of the hernia sac aortic side, dissection of the hernia sac diaphragmatic side, dissection of the hernia sac–pericardial side, divide, division of inferior pulmonary ligament, division of the short gastric vessels, early results, easily reduced, epigastric incision, esophageal lengthening procedure, esophageal lengthening procedures, esophageal mobilization, excised, excision of hernia sac, extensive crural dissection, extensive intrathoracic esophageal dissection, extensive thoracic dissection, females, fibrin glue, fundus of the stomach, gastric fixation, gastropexy, GEJ, giant type IV PEH, greatly facilitates, hernia recurrence, hernia reduction from the ABD, identified, inferior pulmonary vein, inflated with CO2, injury, interrupted non-absorbable sutures, intra-abdominal esophageal length, laparoscopic approach, laparoscopic phase of the procedure, laparoscopic trocars, limited access, LOS, lung, lung isolation, main PA, maneuver, medially, mediastinal structures, mesh, morbidity, mounted liver retractor, Nathansons liver retractor, Nissan Fundoplication confectioning, onlay fashion, opened at the junction, operator side, optimal fundoplication, paraesophageal hernia repair, passed, pathology, PE, penrose drain, pericardium, perioperative deaths, pillars of diaphragmatic crus, planned laparotomy, pneumoperitoneum, posterior crural closure, posterior vagus nerve, posterior window, posteriorly, preserve, proximal mediastinum, pt demographics, pts right side, recurrent PEH, reinflated, remnants of the hernia sac, removal of the hernia sac, results, retraction, safe, safer, secured, separated, sparing, specimen, standard left VATS approach, steep reverse Trendelenberg, superior edge of the hernia sac, superiorly, supine, technique, thoracic aorta, thoracic aotery, thoracic exploration, thoracic portion of the procedure, transfusion, type III, type IV, vagus nerve release, VATS, verified, wider defects, wrap
