Laparoscopic Paraesophageal Hernia Repair and Pulmonary Embolism

Abstract

Objective: Pulmonary embolism (PE) following laparoscopic paraesophageal hernia repair (PEHR) is rare but occurs at a higher frequency than other laparoscopic procedures. We describe a series of patients who developed PEs after PEHR in hopes of capturing potential risk factors for further study.Materials and Methods: Five cases of PE after PEHR were observed between 2017 and 2018. Individual and perioperative risk factors, and postoperative courses were reviewed.Results: Patients had a mean age of 73 years (range, 59 to 86). All were female. Two patients presented acutely. Three patients underwent revisional surgery. The average procedure duration was 248 minutes (range, 162 to 324). All patients had gastrostomy tubes placed. The diagnosis of PE occurred within 3 to 19 days postoperatively. Four were treated with 3 months of oral anticoagulation; 1 was managed expectantly.Conclusions: Highly complex cases, marked by revisional status, need for mesh, large hernia size, and percutaneous endoscopic gastrostomy placement are likely at increased risk for PEs. Preoperative venous thromboembolism chemoprophylaxis should be considered in the majority of laparoscopic PEHR patients.

Comparison of laparoscopic vs. robotic paraesophageal hernia repair: a systematic review

“…With the advent of minimally invasive surgery (MIS), there has been an overall improvement in patient outcomes in terms of morbidity and mortality when compared to trans-thoracic and trans-abdominal open surgical procedures ( 5 , 6 ). The first laparoscopic PEH repair was performed in 1990 and over the years, it has become the gold standard surgical treatment choice for PEH ( 3 , 7 ). Despite ongoing advancements in laparoscopic instruments, there still are technical challenges which surgeons can encounter, such as limited mobility to work in small spaces and reach challenging angles, 2-D image visualization, and suboptimal camera handling or motion ( 4 , 6 ).…”

Effect of timing of perioperative chemical thromboprophylaxis on thromboembolic, bleeding, and other complications during and after antireflux surgery: multicentre cohort study

“…Antireflux surgery including hiatus hernia repairs are becoming increasingly common 1 . Patients undergoing these procedures are at risk of both venous thromboembolism (VTE) and bleeding 2–4 . Both complications can incur significant morbidity, mortality, and healthcare cost.…”