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Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases.

Abstract

Introduction: Diaphragmatic hernia (DH) repair after esophagectomy is infrequent and technically challenging. Such hernias are mostly asymptomatic and have an estimated incidence of around 2.5%. Controversy continues over suture versus mesh cruroplasty. This article reports a series of cases and a description of the technique, showing this type of procedure being performed in the medical literature and its results.

Methods:

A DH was diagnosed, and repair was performed in eight out of 328 esophagectomies. All of them were performed through the following steps: (1) Pulling the hernia content down properly without handling the intestinal segment directly to not promote serosal lesions; (2) Lysis of adhesions-this should be done close to the diaphragmatic pillar, with precaution toward the vessels running in the epiplon and near the greater gastric curvature; and (3) Closure of the diaphragmatic hiatus achieved with anterior and posterior sutures. Mesh repair was performed across the DH defects that measured more than 5.5 cm.

Results:

The patients constituted five men (62.5%) with a mean age of 61.6 years. The main DH-related symptom was abdominal pain, reported by four patients (50%). The other symptoms mentioned were dyspnea (37.5%), thoracic pain (25%), and dysphagia (25%). The mean hospitalization period was 17.5 days and was related to the restoration of the respiratory function. Most of the DH repairs were performed by adopting a laparoscopic approach.

Conclusions:

DH is a rare complication following esophagectomy with most of the symptomatic manifestations. However, its repair is feasible and safe, with low morbidity (only respiratory complications) and no mortality.

Authors+Show Affiliations

Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634027

Citation

Takeda, Flavio R., et al. "Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases." Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 2019.
Takeda FR, Tustumi F, Filho MAS, et al. Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases. J Laparoendosc Adv Surg Tech A. 2019.
Takeda, F. R., Tustumi, F., Filho, M. A. S., Silva, M. O., R Júnior, U., Sallum, R. A. A., & Cecconello, I. (2019). Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, doi:10.1089/lap.2019.0596.
Takeda FR, et al. Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases. J Laparoendosc Adv Surg Tech A. 2019 Oct 21; PubMed PMID: 31634027.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases. AU - Takeda,Flavio R, AU - Tustumi,Francisco, AU - Filho,Marco A S, AU - Silva,Matheus O, AU - R Júnior,Ulysses, AU - Sallum,Rubens A A, AU - Cecconello,Ivan, Y1 - 2019/10/21/ PY - 2019/10/22/entrez PY - 2019/10/22/pubmed PY - 2019/10/22/medline KW - complications KW - diaphragmatic hernia KW - esophagectomy JF - Journal of laparoendoscopic & advanced surgical techniques. Part A JO - J Laparoendosc Adv Surg Tech A N2 - Introduction: Diaphragmatic hernia (DH) repair after esophagectomy is infrequent and technically challenging. Such hernias are mostly asymptomatic and have an estimated incidence of around 2.5%. Controversy continues over suture versus mesh cruroplasty. This article reports a series of cases and a description of the technique, showing this type of procedure being performed in the medical literature and its results. Methods: A DH was diagnosed, and repair was performed in eight out of 328 esophagectomies. All of them were performed through the following steps: (1) Pulling the hernia content down properly without handling the intestinal segment directly to not promote serosal lesions; (2) Lysis of adhesions-this should be done close to the diaphragmatic pillar, with precaution toward the vessels running in the epiplon and near the greater gastric curvature; and (3) Closure of the diaphragmatic hiatus achieved with anterior and posterior sutures. Mesh repair was performed across the DH defects that measured more than 5.5 cm. Results: The patients constituted five men (62.5%) with a mean age of 61.6 years. The main DH-related symptom was abdominal pain, reported by four patients (50%). The other symptoms mentioned were dyspnea (37.5%), thoracic pain (25%), and dysphagia (25%). The mean hospitalization period was 17.5 days and was related to the restoration of the respiratory function. Most of the DH repairs were performed by adopting a laparoscopic approach. Conclusions: DH is a rare complication following esophagectomy with most of the symptomatic manifestations. However, its repair is feasible and safe, with low morbidity (only respiratory complications) and no mortality. SN - 1557-9034 UR - https://www.unboundmedicine.com/medline/citation/31634027/Diaphragmatic_Hernia_Repair_After_Esophagectomy:_Technical_Report_and_Lessons_After_a_Series_of_Cases L2 - https://www.liebertpub.com/doi/full/10.1089/lap.2019.0596?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -