Brunner Stefanie, Müller Dolores T, Eckhoff Jennifer A, Lange Valentin, Chon Seung-Hun, Schmidt Thomas, Schröder Wolfgang, Bruns Christiane J, Fuchs Hans F
Department of General, Visceral, Cancer and Transplantat Surgery, University Hospital of Cologne, 50937 Cologne, Germany.
Faculty of Medicine, University of Cologne, 50923 Cologne, Germany.
J Clin Med. 2023 Sep 19;12(18):6046. doi: 10.3390/jcm12186046.
Postesophagectomy diaphragmatic prolapse (PDP) is a major complication after esophagectomy with significant mortality and morbidity. However, in the current literature, treatment and outcomes are not evaluated for patients undergoing an Ivor Lewis Robot-assisted minimally invasive esophagectomy (IL-RAMIE). The aim of this study is to evaluate the incidence of PDP after IL-RAMIE. Moreover, the study aims to determine whether using a minimally invasive approach in the management of PDP after an IL-RAMIE procedure is safe and feasible.
This study includes all patients who received an IL-RAMIE at our high-volume center (>200 esophagectomies/year) between April 2017 and December 2022 and developed PDP. The analysis focuses on time to prolapse, symptoms, treatment, surgical method, and recurrence rates of these patients.
A total of 185 patients underwent an IL-RAMIE at our hospital. Eleven patients (5.9%) developed PDP. Patients presented with PDP after a medium time of 241 days with symptoms like reflux, nausea, vomiting, and pain. One-third of these patients did not suffer from any symptoms. In all cases, a CT scan was performed in which the colon transversum always presented as the herniated organ. In one patient, prolapse of the small intestine, pancreas, and greater omentum also occurred. A total of 91% of these patients received a revisional surgery in a minimally invasive manner with a mean hospital stay of 12 days. In four patients, PDP recurred (36%) after 13, 114, 119 and 237 days, respectively.
This study shows that a minimally invasive approach in repositioning PDP is a safe and effective option after IL-RAMIE.
食管切除术后膈疝（PDP）是食管切除术后的一种主要并发症，具有较高的死亡率和发病率。然而，在当前文献中，尚未对接受艾弗·刘易斯机器人辅助微创食管切除术（IL-RAMIE）的患者的治疗及预后进行评估。本研究的目的是评估IL-RAMIE术后PDP的发生率。此外，该研究旨在确定在IL-RAMIE术后PDP的管理中采用微创方法是否安全可行。
本研究纳入了2017年4月至2022年12月期间在我们这个高容量中心（每年>200例食管切除术）接受IL-RAMIE并发生PDP的所有患者。分析重点在于这些患者的膈疝发生时间、症状、治疗、手术方法及复发率。
我院共有185例患者接受了IL-RAMIE。11例患者（5.9%）发生了PDP。患者在平均241天的中位时间后出现PDP，伴有反流、恶心、呕吐和疼痛等症状。其中三分之一的患者没有任何症状。在所有病例中，均进行了CT扫描，其中横结肠总是表现为疝出器官。1例患者还发生了小肠、胰腺和大网膜脱垂。这些患者中共有91%以微创方式接受了翻修手术，平均住院时间为12天。4例患者分别在13天、114天、119天和237天后PDP复发（36%）。
本研究表明，在IL-RAMIE术后，采用微创方法复位PDP是一种安全有效的选择。
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