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

De Silva, I; Wee, M; Cabalag, CS; Fong, R; Tran, K; Wu, M; Schloithe, A; Bright, T; Duong, CP; Watson, DI

Author(s): De Silva, I; Wee, M; Cabalag, CS; Fong, R; Tran, K; Wu, M; Schloithe, A; Bright, T; Duong, CP; Watson, DI;
Details: Publication Year 2023-04-29,Volume 36,Issue #5,Page 1-7
Journal Title: Diseases of the Esophagus
Publication Type: Research article
Abstract: 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
Keywords: Humans; Esophagectomy/adverse effects/methods; Retrospective Studies; Postoperative Complications/epidemiology/etiology/surgery; Australia/epidemiology; *Hernia, Hiatal/surgery; *Hernias, Diaphragmatic, Congenital/surgery; *Esophageal Neoplasms/surgery/etiology; Minimally Invasive Surgical Procedures/adverse effects/methods; Treatment Outcome; esophagectomy; hernia; invasive; minimally
Department(s): Surgical Oncology
PubMed ID: 36912068
Publisher's Version: https://doi.org/10.1093/dote/doad011
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-07-19 07:47:30

Last Modified: 2023-07-19 07:47:59