Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2024 May;167(5):1628-1637.e2. doi: 10.1016/j.jtcvs.2023.08.041. Epub 2023 Sep 9.
We hypothesized that emergency complications related to asymptomatic paraconduit hernias may occur less often than generally believed. Therefore, we assessed the occurrence and timing of paraconduit hernia diagnosis after esophagectomy, as well as outcomes of these asymptomatic patients managed with a watch-and-wait approach.
From 2006 to 2021, 1214 patients underwent esophagectomy with reconstruction at the Cleveland Clinic. Among these patients, computed tomography scans were reviewed to identify paraconduit hernias. Medical records were reviewed for timing of hernia diagnosis, hernia characteristics, and patient symptoms, complications, and management. During this period, patients with asymptomatic paraconduit hernias were typically managed nonoperatively.
Paraconduit hernias were identified in 37 patients. Of these, 31 (84%) had a pre-esophagectomy hiatal hernia. Twenty-one hernias (57%) contained colon, 7 hernias (19%) contained pancreas, and 9 hernias (24%) contained multiple organs. Estimated prevalence of paraconduit hernia was 3.3% at 3 years and 7.7% at 10 years. Seven patients (19%) had symptoms, 4 of whom were repaired electively, with 2 currently awaiting repairs. No patient with a paraconduit hernia experienced an acute complication that required emergency intervention.
The risk of paraconduit hernia increases with time, suggesting that long-term symptom surveillance is reasonable. Emergency complications as a result of asymptomatic paraconduit hernias are rare. A small number of patients will experience hernia-related symptoms, sometimes years after hernia diagnosis. Our findings suggest that observation of asymptomatic paraconduit hernias (watch and wait) may be considered, with repair considered electively in patients with persistent symptoms.
我们假设与无症状旁导管疝相关的急诊并发症发生的频率可能低于普遍认为的水平。因此，我们评估了食管切除术后旁导管疝的诊断发生和时间，并评估了这些无症状患者采用观察等待方法的结果。
2006 年至 2021 年，克利夫兰诊所的 1214 例患者接受了食管切除术和重建。在这些患者中，通过计算机断层扫描来识别旁导管疝。回顾病历以确定疝的诊断时间、疝的特征以及患者的症状、并发症和管理情况。在此期间，通常对无症状旁导管疝患者进行非手术治疗。
在 37 例患者中发现旁导管疝。其中 31 例（84%）术前有食管裂孔疝。21 个疝（57%）包含结肠，7 个疝（19%）包含胰腺，9 个疝（24%）包含多个器官。旁导管疝的 3 年和 10 年估计患病率分别为 3.3%和 7.7%。7 例患者（19%）有症状，其中 4 例择期修补，目前有 2 例正在等待修补。没有旁导管疝患者因疝急性并发症而需要紧急干预。
随着时间的推移，旁导管疝的风险增加，这表明长期进行症状监测是合理的。无症状旁导管疝引起的急诊并发症罕见。少数患者会出现疝相关症状，有时在疝诊断后数年。我们的研究结果表明，对于无症状旁导管疝（观察等待），可以考虑观察，对于持续存在症状的患者，可以考虑择期修补。
