OGC P23 Omentopexy Reduces the Incidence of Symptomatic Post-Operative Diaphragmatic Herniation Following Minimally Invasive Oesophagectomy: a 15-year Prospective Study in a UK Specialist Centre. (7th December 2022) - Doe, Matthew
Abstract: Background: Post-oesophagectomy diaphragmatic hernia (PODH) occurs in up to 26% of laparoscopically assisted oesophagectomy. Preventative measures have been suggested, but no formal efficacy data are available. This study compared the incidence of symptomatic PODH before and after introduction of omentopexy in a UK specialist centre. Methods: Consecutive patients undergoing oesophagectomy using a laparoscopic abdominal approach between 2005 and 2020 were included. Omentopexy was introduced in 2014 and was achieved by suture fixation of the greater omentum to the anterior abdominal wall around or lateral to the feeding jejunostomy. Patient demographics, surgical details and complications were collected from a prospective database. All patients were followed up for a minimum of 2 years. Results: Symptomatic PODH developed in 7 of 142 patients (4.9%) in the omentopexy cohort, compared to 9 of 68 patients (13.2%) in the non-omentopexy cohort [Odds Ratio = 0.32 (95% Confidence Interval: 0.12–0.91), p=0.032]. Five of the 9 PODHs in the non-omentopexy cohort developed in the early post-operative period, whereas no early PODHs developed in the omentopexy cohort. There were no complications attributable to omentopexy. Conclusions: Omentopexy is safe and effective at reducing the incidence of symptomatic PODH, particularly in the early post-operative period, and should be routinely performed in all patients undergoing laparoscopically assisted oesophagectomy.