Paraconduit hernia after minimally invasive esophagectomy

Paraconduit hernias, while rare, have garnered increased attention following the adoption of minimally invasive methods for esophagectomy. Minimally invasive esophagectomy (MIE) is associated with an increased incidence of paraconduit hernia as compared with open esophagectomy. No specific strategies are proven for prevention of paraconduit hernia during the index MIE operation, but recognition of preexisting hiatal hernia, reduction of hernia with excision of the sac, and snug closure of the widened hiatus with non-absorbable suture is recommended. Numerous studies have explored the repair of post-MIE paraconduit hernias, with findings supporting repair for symptomatic patients if the patient is a candidate for surgery. Not all paraconduit hernias necessitate surgical intervention. Many are detected incidentally through radiographic imaging and remain asymptomatic, making them amenable to a watch-and-wait approach. Strict adherence to specific criteria for paraconduit hernia repair is imperative, given a high morbidity rate following repair. Additionally, there remains a significant problem of hernia recurrence after repair. There is no consensus as to the best approach for paraconduit hernia repair, and open, laparoscopic, and robotic approaches have all been utilized. This article aims to consolidate and analyze recent research findings, providing surgeons with a comprehensive overview of the current understanding of paraconduit hernias after MIE, and introduce a novel robotic approach for their management.