Baty V, Rocca P, Fontaumard E
Service de Gastroentérologie, Clinique Mutualiste Eugène André, 69424 Lyon, France.
Surg Endosc. 2002 Mar;16(3):538. doi: 10.1007/s00464-001-4226-6. Epub 2002 Jan 9.
Laparoscopic antireflux procedures currently are considered to be as safe, cost efficient, and effective as the techniques used previously in antireflux surgery, although life-threatening complications after antireflux surgery have been reported with both open and laparoscopic fundoplication. We report the case of a 38-year-old man who presented with acute abdominal pain and vomiting 8 months after a laparoscopic Nissen-Rosetti fundoplication. The diagnosis of gastric volvulus was suspected. The endoscopic examination showed a proper location of the fundoplication and features consistent with early gastric ischemia. Rotational maneuvers failed to untwist the volvulus. Emergency surgery was performed, involving a conventional laparotomy. At surgery, the volvulus was found related to a thick adhesion between the opening of the xiphoidal cannula and the hilus hepatis. The section of the adhesion allowed immediate untwisting of the volvulus. Despite a general assumption that laparoscopic procedures will reduce the incidence of postoperative adhesion formation, it should be kept in mind that laparoscopic techniques do not preclude the deposit of unusual foreign microbodies, which is an admitted mechanism of adhesion formation.
目前，腹腔镜抗反流手术被认为与先前抗反流手术中使用的技术一样安全、具有成本效益且有效，尽管无论是开放还是腹腔镜胃底折叠术都曾报告过抗反流手术后的危及生命的并发症。我们报告了一例38岁男性病例，该患者在腹腔镜尼森-罗塞蒂胃底折叠术后8个月出现急性腹痛和呕吐。怀疑诊断为胃扭转。内镜检查显示胃底折叠术位置正确，且有与早期胃缺血相符的特征。旋转手法未能解除扭转。遂进行急诊手术，采用传统剖腹术。手术中发现扭转与剑突下套管开口和肝门之间的致密粘连有关。粘连分离后扭转立即解除。尽管普遍认为腹腔镜手术会降低术后粘连形成的发生率，但应记住，腹腔镜技术并不能排除异常外来微粒的沉积，而这是公认的粘连形成机制。
