EGS P28 Transhiatal oesophagectomy to salvage transacted oesophagus from laparoscopic paraoesophageal hernia repair

Abstract Background Perforation of oesophagus and stomach during paraoesophageal hernia (POH) repair can be caused by traction on the lower oesophagus, gastro-oesophageal junction (GOJ) fundus, or a thermal injury from energy device dissection. Iatrogenic complete transaction elective laparoscopic POH is extremely rare. Here we reported this unusual complication. Methods A 79-year-old man with history hypertension hypothyroidism underwent in district hospital. During surgery, was transacted above level GOJ due to constant GOJ. Patient remained haemodynamically stable transferred our tertiary centre next day. taken theatre for midline laparotomy. Intraoperatively, stomach, omentum transverse colon were chest reduced carefully. The oesophageal stump, approximately 20cm hiatus, found mediastinum use nasogastric tube. It also noted that there several serosal tears proximal left gastric vessels already divided. Unfortunately, stump ischaemic friable. Therefore decided perform transhiatal oesophagectomy. Oesophagus fully mobilised via cervical abdominal incisions resected clavicle. Cervical oesophagogastric anastomosis performed semi-mechanical end-to-side EndoGIA 30mm blue interrupted 3-0 PDS. Postoperatively, he intensive care unit ongoing care. Results off inotropes Day 2 extubated 3 postoperatively. He developed pneumonia atrial fibrillation treated intravenous antibiotics amiodarone. has recovered well currently awaiting transfer ward. Conclusions Complete transection an uncommon Transhiatal oesophagectomy considered as management option selected cases.