Surgical Treatment of Acute Symptomatic Postesophagectomy Diaphragmatic Hernia.

IF 1.1 4区 医学 Q3 SURGERY
Pamela Milito, Stefano Siboni, Andrea Lovece, Eleonora Vico, Roberta De Maron, Valentina Milani, Marco Sozzi, Daniele Bernardi, Emanuele Asti
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Abstract

Background: Postesophagectomy diaphragmatic hernia (PEDH) is a rare yet potentially life-threatening complication following esophagectomy, particularly when acute symptoms such as ischemia or organ perforation arise. Prompt diagnosis and emergency surgical intervention are crucial. This study reports the experience of a tertiary care center in managing acute symptomatic PEDH. Methods: We performed a retrospective analysis of patients who underwent esophagectomy for cancer at our institution between 2013 and 2023. Early PEDH was defined as hernia onset within 30 days postoperatively. Patients presenting with respiratory symptoms, volvulus, ischemia, or perforation underwent emergency surgery. Primary outcomes included the method of diaphragmatic repair, use of mesh, and surgical success. Results: Out of 358 patients, 11 (3.1%) developed PEDH requiring emergency surgery. Five cases were early PEDH and 3 developed an anastomotic leak. Organ or omental resection was performed in 4 patients. Laparoscopic repair was successful in 8 cases, while 2 patients required laparotomy and thoracotomy. Cruroplasty was performed in 8 patients, in 2 a mesh was added and in 6 the falciform ligament was used to buttress the closure. Mortality was nil. Recurrence rate was 18%. No preoperative risk factors for PEDH were identified. Conclusions: Diaphragmatic hernia is a rare but serious complication after esophagectomy, often associated with high morbidity and mortality. Early recognition is critical and life-saving. In high-volume centers, laparoscopic repair is the preferred approach and the decision to perform cruroplasty with or without mesh reinforcement should be individualized based on patient characteristics.

食管切除术后急性症状性膈疝的外科治疗。
背景:食管切除术后膈疝(PEDH)是一种罕见但可能危及生命的并发症,特别是当急性症状如缺血或器官穿孔出现时。及时诊断和紧急手术治疗至关重要。本研究报告三级保健中心管理急性症状PEDH的经验。方法:我们对2013年至2023年在我院接受食管癌切除术的患者进行了回顾性分析。早期PEDH定义为术后30天内出现疝气。出现呼吸道症状、扭转、缺血或穿孔的患者接受紧急手术。主要结果包括膈修复方法、补片的使用和手术成功。结果:在358例患者中,11例(3.1%)发生PEDH,需要紧急手术。早期PEDH 5例,吻合口瘘3例。4例患者行器官或网膜切除术。腹腔镜修复成功8例,开腹开胸2例。8例患者行结缔组织成形术,2例增加补片,6例使用镰状韧带支撑结缔组织。死亡率为零。复发率为18%。术前未发现PEDH的危险因素。结论:膈疝是食管切除术后一种罕见但严重的并发症,通常与高发病率和死亡率相关。早期识别至关重要,可以挽救生命。在大容量的中心,腹腔镜修复是首选的方法,决定是否进行带或不带补片的胆囊成形术应根据患者的特点个性化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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