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Kuvendjiska J, Jasinski R, Hipp J, Fink M, Fichtner-Feigl S, Diener MK, Hoeppner J. Postoperative Hiatal Hernia after Ivor Lewis Esophagectomy-A Growing Problem in the Age of Minimally Invasive Surgery. J Clin Med 2023; 12:5724. [PMID: 37685791 PMCID: PMC10488699 DOI: 10.3390/jcm12175724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Even though minimally invasive esophagectomy is a safe and oncologically effective procedure, several authors have reported an increased risk of postoperative hiatal hernia (PHH). This study evaluates the incidence and risk factors of PHH after hybrid minimally invasive (HMIE) versus open esophagectomy (OE). METHODS A retrospective single-center analysis was performed on patients who underwent Ivor Lewis esophagectomy between January 2009 and April 2018. Computed tomography scans and patient files were reviewed to identify the PHH. RESULTS 306 patients were included (152 HMIE; 154 OE). Of these, 23 patients (8%) developed PHH. Most patients (13/23, 57%) were asymptomatic at the time of diagnosis and only 4 patients (17%) presented in an emergency setting with incarceration. The rate of PHH was significantly higher after HMIE compared to OE (13.8% vs. 1.3%, p < 0.001). No other risk factors for the development of PHH were identified in uni- or multi-variate analysis. Surgical repair of PHH was performed in 19/23 patients (83%). The recurrence rate of PHH after surgical repair was 32% (6/19 patients). CONCLUSIONS The development of PHH is a relevant complication after hybrid minimally invasive esophagectomy. Although most patients are asymptomatic, surgical repair is recommended to avoid incarceration with potentially fatal outcomes. Innovative techniques for the prevention and repair of PHH are urgently needed.
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Affiliation(s)
- Jasmina Kuvendjiska
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Robert Jasinski
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Julian Hipp
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Mira Fink
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
| | - Markus K. Diener
- Department of General and Visceral Surgery, University Medical Center, 79106 Freiburg, Germany
| | - Jens Hoeppner
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79085 Freiburg, Germany
- Department of Surgery, University Medical Center Schleswig-Holstein, 23538 Lübeck, Germany
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Garcia-Urena MÁ, Lopez-Monclus J, de Robin Valle de Lersundi A, Blazquez Hernando LA, Medina Pedrique M, Rial Justo X, Cruz Cidoncha A, Nogueira Sixto M, Munoz-Rodriguez J. Pathways of the preperitoneal plane: from the “fatty triangle” in Rives to the “fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute to Prof. Schumpelick. Hernia 2022; 27:395-407. [PMID: 35426573 DOI: 10.1007/s10029-022-02602-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/08/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. METHODS Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. RESULTS The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. CONCLUSION The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.
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Affiliation(s)
- M Á Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - J Lopez-Monclus
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain.
| | - A de Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - L A Blazquez Hernando
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, M-607, 9,100, 28034, Madrid, Spain
| | - M Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - X Rial Justo
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - A Cruz Cidoncha
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - M Nogueira Sixto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Alvaro Cunqueiro, Estrada de Clara Campoamor 341, 36213, Vigo, Spain
| | - J Munoz-Rodriguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain
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