OGC P23 Omentopexy reduces the incidence of Symptomatic Post- Esophagectomy Diaphragmatic Herniation Following Laparoscopically Assisted Oesophagectomy: 15 years of experience from a UK Specialist Center.
Doe, Matthew Jones, Michael Dwerryhouse, Simon Hornby, Steve Messenger, David Wadley, Martin
Doe, Matthew
Jones, Michael
Dwerryhouse, Simon
Hornby, Steve
Messenger, David
Wadley, Martin
Date
2023-06-07
Journal Title
Subject
Type
Conference Abstract
Collections
Abstract
Objectives: Post-esophagectomy diaphragmatic herniation (PEDH) is a recognized complication of laparoscopically assisted esophagectomy (LAE) and occurs in up to 26% of cases. Several preventative measures have been reported but no formal efficacy data are available. LAE has been undertaken since 2005 in our tertiary specialist oesophagogastric unit with a PEDH of 13.2% in our initial published experience. Subsequently, a novel technique of laparoscopic omentopexy was introduced to reduce the incidence of PEDH. Therefore, the objective of this study was to determine the effectiveness of omentopexy in reducing symptomatic PEDH requiring operative intervention.
Methods and Procedures: Details on consecutive patients undergoing LAE in our unit were extracted from a prospectively maintained, institution-approved, esophageal resection database since 2005. Data were collected on patient demographics, neoadjuvant treatment, operative technique, morbidity, and survival. Patient records were also reviewed from referring centers to maximise data capture on the development and timing of symptomatic PEDH. Laparoscopic Omentopexy involved suturing the left-side of the greater omentum to the abdominal wall of the left upper quadrant, either by splitting the omentum into two pedicles and affixing around the site of feeding jejunostomy (Fig. 1) or by simple fixation alone, with minimal omental redundancy between the colon and fixation site.
Result(s): A total of 243 patients underwent LAE (9 underwent thoracoscopic second stage) with a median follow-up of 23.8 months. 7/142 patients undergoing omentopexy (4.9%) developed symptomatic PEDH necessitating repair, compared to 13/101 patients (12.9%) in the non-omentopexy group [Hazard Ratio = 0.32 (95% Confidence Interval(CI): 0.12-0.80), p = 0.011]. This translated to a 1-year PEDH-free survival of 96.2% (95%CI: 91.1%-98.4%) in the omentopexy cohort and 87.8% (95%CI: 78.9%-93.1%) in the nonomentopexy cohort (Fig. 2). Of the 7 PEDHs in the omentopexy cohort, only one PEDH (14.2%) developed within 30 days of surgery, compared to 6/13 PEDHs (46.2%) in the non-omentopexy cohort (p = 0.329). No demographic or treatment factors contributed to the risk of PEDH. No complications could be attributed to omentopexy.
Conclusion(s): Omentopexy is safe and effective at reducing the incidence of symptomatic PEDH and may be of greatest benefit in the early post-operative period. This simple and low-risk technique should be considered in all patients undergoing the laparoscopic abdominal phase of esophagectomy and merits further study in the randomized controlled trial setting.
Citation
Doe M., Brown O.D., Jones M., Dwerryhouse S., Miggs S.M., Hornby S., Wadley M. (2023). Omentopexy reduces the incidence of Symptomatic Post- Esophagectomy Diaphragmatic Herniation Following Laparoscopically Assisted Oesophagectomy: 15 years of experience from a UK Specialist Center. Surgical Endoscopy, 37(Supplement 2), S495. https://doi.org/10.1007/s00464-023-10072-3