Para-conduit diaphragmatic hernia following esophagectomy—the new price of minimally invasive surgery?

Author:

De Silva Inoka1,Wee Melissa1,Cabalag Carlos S2,Fong Rebecca1,Tran Kevin2,Wu Michael2,Schloithe Ann3,Bright Tim13,Duong Cuong Phu2,Watson David I13ORCID

Affiliation:

1. Department of Surgery, Flinders Medical Centre , Bedford Park, SA , Australia

2. Division of Cancer Surgery, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia

3. Discipline of Surgery, College of Medicine and Public Health, Flinders University , Bedford Park, SA , Australia

Abstract

Summary Esophageal Cancer is the seventh commonest cancer worldwide with poor overall survival. Significant morbidity related to open esophagectomy has driven practice toward hybrid, totally minimally invasive and robotic procedures. With the increase in minimally invasive approaches, it has been suggested that there might be an increased incidence of subsequent para-conduit diaphragmatic hernia. To assess the incidence, modifiable risk factors and association with operative approach of this emerging complication, we evaluated outcomes following esophagectomy from two Australian Centers. Prospectively collected databases were examined to identify patients who developed versus did not develop a para-conduit hernia. Patient characteristics, disease factors, treatment factors, operative and post-operative factors were compared for these two groups. A total of 24 of 297 patients who underwent esophagectomy were diagnosed with a symptomatic para-conduit diaphragmatic hernia (8.1%). The significant risk factor for hernia was a minimally invasive abdominal approach (70.8% vs. 35.5%; P = 0.004, odds ratio = 12.876, 95% CI 2.214–74.89). Minimally invasive thoracic approaches were not associated with increased risk. Minimally invasive abdominal approaches to esophagectomy doubled the risk of developing a para-conduit diaphragmatic hernia. Effective operative solutions to address this complication are required.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,General Medicine

Reference14 articles.

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3. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial;Biere;Lancet,2012

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