Para-conduit diaphragmatic hernia following esophagectomy-the new price of minimally invasive surgery? 2023

Inoka De Silva, and Melissa Wee, and Carlos S Cabalag, and Rebecca Fong, and Kevin Tran, and Michael Wu, and Ann Schloithe, and Tim Bright, and Cuong Phu Duong, and David I Watson
Department of Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.

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.

UI MeSH Term Description Entries
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D004938 Esophageal Neoplasms Tumors or cancer of the ESOPHAGUS. Cancer of Esophagus,Esophageal Cancer,Cancer of the Esophagus,Esophagus Cancer,Esophagus Neoplasm,Neoplasms, Esophageal,Cancer, Esophageal,Cancer, Esophagus,Cancers, Esophageal,Cancers, Esophagus,Esophageal Cancers,Esophageal Neoplasm,Esophagus Cancers,Esophagus Neoplasms,Neoplasm, Esophageal,Neoplasm, Esophagus,Neoplasms, Esophagus
D006551 Hernia, Hiatal STOMACH herniation located at or near the diaphragmatic opening for the ESOPHAGUS, the esophageal hiatus. Hernia, Esophageal,Hernia, Paraesophageal,Hiatal Hernia,Esophageal Hernia,Hernia, Hiatus,Paraesophageal Hiatal Hernia,Sliding Esophageal Hernia,Sliding Hiatal Hernia,Esophageal Hernia, Sliding,Esophageal Hernias,Esophageal Hernias, Sliding,Hernia, Paraesophageal Hiatal,Hernia, Sliding Esophageal,Hernia, Sliding Hiatal,Hernias, Esophageal,Hernias, Hiatal,Hernias, Hiatus,Hernias, Paraesophageal,Hernias, Paraesophageal Hiatal,Hernias, Sliding Esophageal,Hernias, Sliding Hiatal,Hiatal Hernia, Paraesophageal,Hiatal Hernia, Sliding,Hiatal Hernias,Hiatal Hernias, Paraesophageal,Hiatal Hernias, Sliding,Hiatus Hernia,Hiatus Hernias,Paraesophageal Hernia,Paraesophageal Hernias,Paraesophageal Hiatal Hernias,Sliding Esophageal Hernias,Sliding Hiatal Hernias
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001315 Australia The smallest continent and an independent country, comprising six states and two territories. Its capital is Canberra. Canton and Enderbury Islands,Christmas Island,Christmas Island (Australia)
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D016629 Esophagectomy Excision of part (partial) or all (total) of the esophagus. (Dorland, 28th ed) Esophagectomies
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D019060 Minimally Invasive Surgical Procedures Procedures that avoid use of open, invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-controlled manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. Minimal Access Surgical Procedures,Minimal Surgical Procedures,Minimally Invasive Surgical Procedure,Surgical Procedures, Minimally Invasive,Minimal Surgical Procedure,Minimally Invasive Surgery,Procedure, Minimal Surgical,Procedures, Minimal Access Surgical,Procedures, Minimal Surgical,Procedures, Minimally Invasive Surgical,Surgical Procedure, Minimal,Surgical Procedures, Minimal,Surgical Procedures, Minimal Access,Minimally Invasive Surgeries,Surgeries, Minimally Invasive,Surgery, Minimally Invasive
D065630 Hernias, Diaphragmatic, Congenital Protrusion of abdominal structures into the THORAX as a result of embryologic defects in the DIAPHRAGM often present in the neonatal period. It can be isolated, syndromic, non-syndromic or be a part of chromosome abnormality. Associated pulmonary hypoplasia and PULMONARY HYPERTENSION can further complicate stabilization and surgical intervention. Bochdalek Hernia,Congenital Diaphragmatic Hernia,Congenital Diaphragmatic Hernias,Morgagni Hernia,Morgagni's Hernia,Agenesis of Hemidiaphragm,Bochdalek Hernias,Congenital Diaphragmatic Defect,Morgagni Hernias,Morgagni's Hernias,Unilateral Agenesis of Diaphragm,Congenital Diaphragmatic Defects,Defect, Congenital Diaphragmatic,Defects, Congenital Diaphragmatic,Diaphragm Unilateral Ageneses,Diaphragm Unilateral Agenesis,Diaphragmatic Defect, Congenital,Diaphragmatic Defects, Congenital,Diaphragmatic Hernia, Congenital,Diaphragmatic Hernias, Congenital,Hemidiaphragm Ageneses,Hemidiaphragm Agenesis,Hernia, Bochdalek,Hernia, Congenital Diaphragmatic,Hernia, Morgagni,Hernia, Morgagni's,Hernias, Bochdalek,Hernias, Congenital Diaphragmatic,Hernias, Morgagni,Hernias, Morgagni's,Morgagnis Hernia,Morgagnis Hernias

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