International expert consensus on the management of paraconduit herniation after esophagectomy: results of a two-round Delphi survey
Abstract
Aims: The management of Paraconduit Herniation after Esophagectomy (PCH) is controversial. This survey aims to identify recommended strategies for prevention and patient handling (including indication, preoperative work-up, technical-surgical details and follow-up) using the Delphi methodology.
Methods: We conducted a 2-round, 32-question, web-based International Delphi survey focusing on non-revisional, elective PCH in asymptomatic patients among surgical upper GI experts. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%.
Results: Eighty-two surgeons with a median (IQR) experience of 17.5 (12-27) years from 19 countries across four continents (Europe, North America, Asia, Australia) participated in both Delphi rounds (response rate 43%). The annual median (IQR) individual and institutional caseload was 5 (5-5) and 5 (5-10) PCH surgeries, respectively. After Delphi round 2, strong expert consensus (> 75% agreement) was achieved for: (1) Preventive measures: avoiding opening the left pleura during index esophagectomy; (2) Indications for repair: prioritizing biologically younger (< 80 years) and tumor-free patients, complex multi-organ herniation, and radiographically enlarging PCH on surveillance, while explicitly discouraging repair for stable PCH or tumor recurrence; (3) Surgical approach:…
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