In:
Diseases of the Esophagus, Oxford University Press (OUP), Vol. 35, No. Supplement_2 ( 2022-09-24)
Abstract:
Our approach to the repair of giant paraesophageal hernia (GPEH) has undergone a paradigm shift. In cases with predominantly obstructive symptoms, following hernia repair, we have transitioned from a mandatory antireflux procedure to a comprehensive extended gastropexy. Further, we have successfully adopted the robotic platform, faithfully replicating the tenets of the operation that we previously refined using the laparoscopic approach. The objective of this study was to describe operative outcomes with this approach. With IRB approval, we retrospectively analyzed prospectively collected data. Operative technique included complete mediastinal dissection of the hernia sac, reduction of contents, tension free return of the stomach to its normal intraabdominal position, preservation of the crural lining, and repair of the crura with nonabsorbable suture. For patients with predominantly obstructive symptoms and minimal reflux, in lieu of an antireflux procedure, we performed an extended gastropexy involving accentuation of the angle of His and placement of a series of horizontal mattress sutures between the greater curvature of the stomach along the line of the short gastric vessels and the diaphragm. Between 2014 and 2021, 113 patients underwent robotic GPEH repair with gastropexy (median age 74.3 ± 9.05 years, 79.6% female, elective 78.7% vs. 21.2% urgent). Majority were Type III GPEH (75.2% vs 24.7% Type IV) and 22.3% had an organ-axial volvulus. Most common presenting symptoms were dysphagia (35.4%), vomiting (23.8%) and chest pain (17.7%). All operations were completed robotically. Cardinal tenets of GPEH repair were achieved in all cases. Average length of stay was 5.85 ± 5.18 days. Two patients (1.7%) died within 30 days, and 24.7% developed a postoperative complication, 13 (11.5%) were readmitted and 4 (3.5%) required reoperation. In patients with a GPEH who have predominantly obstructive symptoms, a robotic approach that adheres to the principal tenets of GPEH repair with an extended gastropexy in lieu of an antireflux procedure appears to be feasible and safe. Further studies that evaluate functional outcome and long-term follow-up to assess durability appear to be warranted.
Type of Medium:
Online Resource
ISSN:
1120-8694
,
1442-2050
DOI:
10.1093/dote/doac051.631
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2022
detail.hit.zdb_id:
2004949-3
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