A novel approach for the treatment of Morgagni hernias: robotic transabdominal preperitoneal diaphragmatic hernia repair.

PURPOSE: We introduce a novel approach to the surgical repair of Morgagni hernias (MHs) utilizing the robotic transabdominal preperitoneal repair (rTAPP) approach. Borrowed from our previous and robust experience with rTAPP repairs for hernias of the anterior abdominal wall, this technique boasts the benefits of hernia sac reduction, the use of an uncoated mesh in an extraperitoneal plane, and minimal fixation leading to lower postoperative pain relative to other approaches. METHODS: To evaluate the effectiveness of this novel approach, five consecutive symptomatic Morgagni hernias (MHs) were repaired with the rTAPP approach. The size of the defect, mesh size, length of stay, follow-up imaging, and follow-up complications were documented for comparison. RESULTS: The size of the MH defects ranged from 4 × 6 cm to 5 × 10 cm. LOS was an average of 1.2 days. Two out of the five patients underwent concomitant repair of a lower abdominal hernias (one Spigelian hernia, and one indirect inguinal hernia). Outpatient follow-up from surgery ranged anywhere from 6 months to 4 years, with most patients receiving follow-up after 1 year. Four out of the five patients received follow-up CT scans to confirm the absence of hernia recurrence. One patient experienced an incisional hernia from the midline 12-mm port site which was repaired 1 year after. CONCLUSION: We propose a new technique for a minimally invasive strategy to treat these complex hernias utilizing an rTAPP technique resulting in minimal length of stay and a durable result in long-term follow-up. The benefits of repair, which include minimal postoperative pain, minimal length of stay, and cost-effective prosthetic mesh hidden from the visceral contents, are consistent with the author's experience for rTAPP repairs for hernias of the anterior abdominal wall.

Important prognostic factors in leiomyosarcoma survival: a National Cancer Database (NCDB) analysis.

BACKGROUND: Leiomyosarcoma (LMS) is an aggressive, malignant mesenchymal tumor with characteristic smooth muscle lineage accounting for 10-20% of all soft tissue tumors. The goal of this study is to determine the impact of prognostic factors on leiomyosarcoma survival irrespective of primary anatomical site. METHODS: There were a total of 7154 patients with primary leiomyosarcoma identified and analyzed from the National Cancer Database. Descriptive statistics, median survival, and 5- and 10-year survival probabilities were calculated along with a Cox proportional hazard model to determine independent prognostic factors. RESULTS: In this study, females comprised 68.3% of the cohort with a median age of 58 years. The most common primary anatomical sites were the extremities followed by female reproductive organs, abdomen, pelvis, thorax or lung, and head or neck. Tumors localized in the female reproductive organs had the worst survival (5-year survival probability: 45.3%), while tumors localized in the extremities had the best survival outcomes (5-year survival probability: 73.4%). Surgery with adjuvant radiation yielded better outcomes compared to surgery alone (HR 0.82, 95% CI 0.74-0.91). Microscopic and macroscopic margins resulted in a 32% and a 134% increased risk in mortality, respectively, when compared to negative surgical margins (p < 0.0001). CONCLUSION: This study showed a significantly higher risk of mortality associated with older patients, tumors localized to the female reproductive organs, African American patients, higher tumor stage, increased Charlson/Deyo scores, tumors treated with surgery alone without adjuvant radiation, and tumors with positive microscopic, macroscopic, or indeterminate surgical margins.