386 Experience of Paraconduit Hernia After Oesophagectomy in a High Volume Minimally Invasive Foregut Cancer Centre

Abstract Introduction Paraconduit hernia occurs uncommonly after oesophagectomy, with the displacement of abdominal contents through the post operative hiatus into the thorax. Clinical presentations vary from asymptomatic to life-threatening visceral ischaemia and can present many years post-operatively. As such, they present a dilemma to oesophageal surgeons in respect of diagnosis and appropriate management. A minimally invasive approach has been repeatedly cited as a risk factor for hernia formation. Method A prospectively maintained database of oeospahgectomies performed at our centre was interrogated from 2019–2023. Demographics, operative approach andclinico-pathological data were extracted. Statistical analyses were conducted using MinitabTM v18. Results From 2019–2023 190 oesophagectomies were completed of which 76%(145) were oesoaphgeal and 24% (45) were oesophago-gastric junctional tumours. The mean age was 66 years ( +/- 9.8 years) and male patients represented 78% of cases. The distribution of surgical approach was Minimally invasive oesophagectomy (MIO)65/190, Robotically assisted minimally invasive oesophagectomy (RAMIO)63/190, Open 2/190 and Hybrid 60/190. The overall rate of paraconduit hernia was 11.6% (22/190). 5/22 occurred within 3 months of oesophagectomy and 10/22 presented symptomatically. The most common organ to herniate was the transverse colon in 19 cases, followed by small bowel in 6. The rate of herniation among the different approaches was hybrid 4/60, RAMIO 12/63 and MIO 6/65 p-0.076. Conclusions The rates of paraconduit hernia at our institution are comparable to international standards. The transition towards a more minimally invasive approach to oesophagectomy and the adoption of robotic platforms to achieve it has not significantly impacted the rate of hernia development.