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Congenital paraesophageal hernia: Contemporary results and outcomes of laparoscopic approach to repair in symptomatic infants and children.
J Pediatr Surg. 2019 Jul; 54(7):1346-1350.JP

Abstract

BACKGROUND

Congenital paraesophageal hernia (CPEH) is a rare diaphragmatic anomaly for which repair has primarily been described by laparotomy, although, more recent case series describe laparoscopic repair. In reports with over five patients, the predominant approach has been with laparotomy. The purpose of our study was to review our recent institutional experience and results with exclusively laparoscopic repair of CPEH in infants and children.

METHODS

An IRB approved retrospective review of all patients with CPEH who underwent laparoscopic treatment at a tertiary children's hospital from 2010 to 2017 was performed. We included only those patients from our own institution with primary CPEH, or CPEH with prior repair (s) at other centers, with recurrence presenting for operation. Data including demographics, diagnostic studies, operative details, complications, outcomes, and follow up were analyzed. Age at diagnosis was 1 day to 25 years of age (mean 2.5 years).

RESULTS

A total 28 patients underwent 30 operations to treat CPEH. All operations were completed laparoscopically with no conversions to open. There were 6 Type II, 16 Type III, and 6 Type IV CPEH patients. Seventeen patients were less than one year of age (61%). Weight at time of repair was 10.3 kg (1.2-44 kg). Twelve patients were less than 5 kg (43%), eight patients (28.5%) were less than 10 kg, and 8 were more than 10 kg (28.5%). Operative time averaged 125 min (range 61-247 min). Three patients underwent initial CPEH repair (s) (open: 2 and laparoscopic: 1) at other institutions before laparoscopic revision was performed at our hospital (11%). Crural repair was performed in all patients, fundoplication in 26 (93%) and concomitant gastrostomy was performed in 14 patients (50%). Complications included two patients with recurrent hiatal hernias, which were redone laparoscopically (2/28 or 7% recurrence) and 1 capnothorax requiring pigtail drainage postoperatively. There were no deaths, no requirement for esophageal dilations, or esophageal lengthening. One patient required laparoscopic gastrostomy six weeks post initial repair for failure to thrive. Follow-up ranged from 4 months to 8 years (average 36 months).

CONCLUSION

Congenital paraesophageal hernia in infants and children is uncommon. Based on our experience, the laparoscopic approach to repair is feasible, even for neonates, with excellent results, acceptably low recurrence rate, and may even be considered for revisional operations.

STUDY TYPE

Clinical research paper.

LEVEL OF EVIDENCE

Type IV.

Authors+Show Affiliations

Children's National Medical Center, Division of General & Thoracic Surgery, 111 Michigan Avenue NW., Washington, DC, 20010.Children's National Medical Center, Division of General & Thoracic Surgery, 111 Michigan Avenue NW., Washington, DC, 20010; Howard University School of Medicine, Department of Surgery, Washington, DC. 20010.Children's National Medical Center, Division of General & Thoracic Surgery, 111 Michigan Avenue NW., Washington, DC, 20010.Children's National Medical Center, Division of General & Thoracic Surgery, 111 Michigan Avenue NW., Washington, DC, 20010.Children's National Medical Center, Division of General & Thoracic Surgery, 111 Michigan Avenue NW., Washington, DC, 20010.Children's National Medical Center, Division of General & Thoracic Surgery, 111 Michigan Avenue NW., Washington, DC, 20010. Electronic address: TKane@Childrensnational.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30072216

Citation

Petrosyan, Mikael, et al. "Congenital Paraesophageal Hernia: Contemporary Results and Outcomes of Laparoscopic Approach to Repair in Symptomatic Infants and Children." Journal of Pediatric Surgery, vol. 54, no. 7, 2019, pp. 1346-1350.
Petrosyan M, Shah AA, Chahine AA, et al. Congenital paraesophageal hernia: Contemporary results and outcomes of laparoscopic approach to repair in symptomatic infants and children. J Pediatr Surg. 2019;54(7):1346-1350.
Petrosyan, M., Shah, A. A., Chahine, A. A., Guzzetta, P. C., Sandler, A. D., & Kane, T. D. (2019). Congenital paraesophageal hernia: Contemporary results and outcomes of laparoscopic approach to repair in symptomatic infants and children. Journal of Pediatric Surgery, 54(7), 1346-1350. https://doi.org/10.1016/j.jpedsurg.2018.07.008
Petrosyan M, et al. Congenital Paraesophageal Hernia: Contemporary Results and Outcomes of Laparoscopic Approach to Repair in Symptomatic Infants and Children. J Pediatr Surg. 2019;54(7):1346-1350. PubMed PMID: 30072216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Congenital paraesophageal hernia: Contemporary results and outcomes of laparoscopic approach to repair in symptomatic infants and children. AU - Petrosyan,Mikael, AU - Shah,Adil A, AU - Chahine,A Alfred, AU - Guzzetta,Philip C, AU - Sandler,Anthony D, AU - Kane,Timothy D, Y1 - 2018/07/20/ PY - 2018/03/26/received PY - 2018/07/05/revised PY - 2018/07/12/accepted PY - 2018/8/4/pubmed PY - 2019/11/14/medline PY - 2018/8/4/entrez KW - Congenital paraesophageal hernia KW - Giant hiatal hernia KW - Laparoscopic surgery SP - 1346 EP - 1350 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 54 IS - 7 N2 - BACKGROUND: Congenital paraesophageal hernia (CPEH) is a rare diaphragmatic anomaly for which repair has primarily been described by laparotomy, although, more recent case series describe laparoscopic repair. In reports with over five patients, the predominant approach has been with laparotomy. The purpose of our study was to review our recent institutional experience and results with exclusively laparoscopic repair of CPEH in infants and children. METHODS: An IRB approved retrospective review of all patients with CPEH who underwent laparoscopic treatment at a tertiary children's hospital from 2010 to 2017 was performed. We included only those patients from our own institution with primary CPEH, or CPEH with prior repair (s) at other centers, with recurrence presenting for operation. Data including demographics, diagnostic studies, operative details, complications, outcomes, and follow up were analyzed. Age at diagnosis was 1 day to 25 years of age (mean 2.5 years). RESULTS: A total 28 patients underwent 30 operations to treat CPEH. All operations were completed laparoscopically with no conversions to open. There were 6 Type II, 16 Type III, and 6 Type IV CPEH patients. Seventeen patients were less than one year of age (61%). Weight at time of repair was 10.3 kg (1.2-44 kg). Twelve patients were less than 5 kg (43%), eight patients (28.5%) were less than 10 kg, and 8 were more than 10 kg (28.5%). Operative time averaged 125 min (range 61-247 min). Three patients underwent initial CPEH repair (s) (open: 2 and laparoscopic: 1) at other institutions before laparoscopic revision was performed at our hospital (11%). Crural repair was performed in all patients, fundoplication in 26 (93%) and concomitant gastrostomy was performed in 14 patients (50%). Complications included two patients with recurrent hiatal hernias, which were redone laparoscopically (2/28 or 7% recurrence) and 1 capnothorax requiring pigtail drainage postoperatively. There were no deaths, no requirement for esophageal dilations, or esophageal lengthening. One patient required laparoscopic gastrostomy six weeks post initial repair for failure to thrive. Follow-up ranged from 4 months to 8 years (average 36 months). CONCLUSION: Congenital paraesophageal hernia in infants and children is uncommon. Based on our experience, the laparoscopic approach to repair is feasible, even for neonates, with excellent results, acceptably low recurrence rate, and may even be considered for revisional operations. STUDY TYPE: Clinical research paper. LEVEL OF EVIDENCE: Type IV. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/30072216/Congenital_paraesophageal_hernia:_Contemporary_results_and_outcomes_of_laparoscopic_approach_to_repair_in_symptomatic_infants_and_children_ DB - PRIME DP - Unbound Medicine ER -