Esophageal Lengthening in Paraesophageal Hernia Repair: When and How
Sadia Tasnim, Siva Raja, Sudish Murthy, Monisha Sudarshan.
Cleveland Clinic Foundation, Cleveland, OH, USA.
Summary: In this video, we discuss esophageal lengthening in paraesophageal hernia repair: when and how. Determination of intra-abdominal esophageal length is a key step in a paraesophageal hernia repair. Ideally 2.5-3cm of intra-abdominal esophageal length is desired after mediastinal mobilization. A short intra-abdominal esophageal length contributes to hernia recurrence. There are certain predictors for short esophagus, however, the diagnosis is made intraoperatively. There are multiple techniques of esophageal lengthening: open, minimally invasive, transthoracic. Wedge gastroplasty is a common transabdominal technique and requires standard port placement. Transthoracic stapling is another technique that can be performed from the right or left side but requires the placement of an intrathoracic port. We demonstrate 2 videos for wedge gastroplasty and left transthoracic stapling. Finally, we compare the pros and cons of each approach.
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