Gryska P V, Vernon J K
Department of Surgery, Newton-Wellesley Hospital, Newton, MA 02462, USA.
Hernia. 2005 May;9(2):150-5. doi: 10.1007/s10029-004-0312-8. Epub 2005 Feb 19.
The breakdown of a hiatal hernia repair can lead to clinical failure. The use of prosthetic material at the esophageal hiatus to strengthen the crural repair is relatively new and questions remain. This report examines the safety and efficacy of a tension-free crural repair with mesh.
Since 1993, 135 consecutive patients (19-86) [9 re-do] completed laparoscopic tension-free hiatal hernia repair prior to Nissen wrap. Esophageal hiatus was patched with a PTFE mesh (first 112 patients) or a PTFE/ePTFE composite (23 patients) secured across the defect with staples to each crura. 130 patients completed a phone questionnaire during 2003/2004 (mean f/u 64 months).
There have been no short-term nor long-term infections related to the PTFE mesh. Symptoms were resolved or improved and resolved with meds in 122/130 (94%). Early re-herniation occurred in one patient after vigorous exercise.
Mesh repair/patch of the esophageal hiatus can be done without infection, with results similar to standard crural repair and consistent with surgical principles of non-tension.
食管裂孔疝修补失败可导致临床治疗失败。在食管裂孔处使用人工材料加强膈肌脚修复是相对较新的方法，仍存在一些问题。本报告探讨了使用补片进行无张力膈肌脚修复的安全性和有效性。
自1993年以来，135例连续患者（年龄19 - 86岁）[9例为再次手术]在进行Nissen胃底折叠术之前完成了腹腔镜无张力食管裂孔疝修补术。食管裂孔用聚四氟乙烯（PTFE）补片（前112例患者）或PTFE/膨体聚四氟乙烯（ePTFE）复合材料（23例患者）修补，用吻合器固定于每个膈肌脚以覆盖缺损。2003/2004年期间，130例患者完成了电话问卷调查（平均随访64个月）。
未发生与PTFE补片相关的短期或长期感染。122/130例（94%）患者的症状得到缓解或改善，部分患者经药物治疗后症状缓解。1例患者在剧烈运动后早期出现复发。
食管裂孔的补片修复可避免感染，效果与标准膈肌脚修复相似，符合无张力手术原则。
