Abstract
Introduction:
Diaphragmatic hernia (DH) repair after esophagectomy is infrequent and technically challenging and requires significant experience in advanced foregut surgery. 1,2 These hernias may be asymptomatic and has an estimated incidence ∼2.5%. 3 This video shows and demonstrates the technique adopted for a patient with a DH after an esophagectomy. This is one of the initial videos demonstrating this type of procedure.
Methods:
A 63-year-old female patient underwent a transthoracic esophagectomy with routine oncologic follow-up at 2 years postoperatively with a CT. An asymptomatic DH was diagnosed. After discussing the procedure in the outpatient setting, a laparoscopic DH repair was performed. Initially, the herniated contents were reduced, and a lysis of adhesions was performed. The hiatal defect was then closed with a multifilament strand of unabsorbable cotton, with anterior and posterior sutures. Next, a U-shaped bovine pericardium patch was secured on top of the cruroplasty.
Results:
The patient initiated a liquid diet on the second postoperative day. There was a good clinical evolution, with adequate acceptance of the diet, without dysphagia. Hospital discharge occurred on the third postoperative day, without complications. In the outpatient follow-up, the patient maintained a good acceptance of the diet, with weight maintenance, and remained clinically asymptomatic. A 2-year follow-up CT did not document a recurrent hiatal hernia.
Conclusions:
In summary, diaphragmatic hernioplasty is a feasible option as long as special attention is given to preserving the gastric tube and epiploic vessels during lysis of adhesions. Some strategies have been proposed to reduce a DH after esophagectomy by a prophylactic cruroplasty, minimizing the hiatal widening or adding a colopexy.
No competing financial interests exist.
Runtime of video: 7 mins 43 secs
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