Endzinas Zilvinas, Jonciauskiene Jelena, Mickevicius Antanas, Kiudelis Mindaugas
Department of Surgery, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
Medicina (Kaunas). 2007;43(1):27-31.
To determine the influence of hiatal hernia size and the laparoscopic fundoplication technique on the rate of hernia recurrence.
The preoperative, operative, and postoperative observational data of 381 patients operated on at the Department of Surgery of Kaunas University of Medicine during the period of 1998-2004 for hiatal hernia complicated with gastroesophageal reflux were analyzed. The surgery technique (Nissen or Toupet operation) was chosen independently of the hernia size. The radiological investigation of the esophagus-stomach using barium contrast as well as esophagogastroduodenoscopy and biopsy was performed for all patients before the surgery. The subjective and objective assessment of the patients' health status was investigated before and no less than 12 months after surgery. If the disease symptoms remained or new ones (i.e. pain behind the sternum, dysphagia, etc.) occurred after surgery, the hernia recurrence was suspected. The radiological investigation of the esophagus-stomach using barium contrast, as well as esophagogastroduodenoscopy and biopsy were performed at the consultative outpatient clinic. The hernia recurrence was confirmed after performing these two investigations. When analyzing the results, the patients were divided into two groups: Group 1--patients with small hiatal hernia (grade 1 and 2 hernia according to radiological classification), Group 2--patients with large hiatal hernia (grade 3 and 4 hernia according to radiological classification).
A total of 272 (71.4%) patients had small hiatal hernia, and 109 (28.6%) patients had large ones. Hernia recurrence was diagnosed in 7 (2.58%) patients in Group 1, while in Group 2, 11 (10.1%) patients had hernia recurrence (P<0.05). Laparoscopic Nissen fundoplication was performed in 287 (75.4%) patients, after which 14 (4.98%) patients had hernia recurrence, while Toupet fundoplication was performed in 94 (24.6%) patients, after which 4 (4.3%) patients had hernia recurrence (P>0.05).
The recurrence rate of hiatal hernia after laparoscopic fundoplications is significantly higher in patients with large hernias (grade 3 and 4 according to radiological classification). The surgery technique (Nissen or Toupet fundoplication) was not a significant factor affecting the recurrence rate of hiatal hernia.
确定食管裂孔疝大小及腹腔镜胃底折叠术技术对疝复发率的影响。
分析了1998年至2004年期间在考纳斯医科大学外科接受手术的381例因食管裂孔疝合并胃食管反流而手术患者的术前、术中及术后观察数据。手术技术（nissen或Toupet手术）的选择与疝大小无关。所有患者在手术前均采用钡剂造影对食管胃进行放射学检查，以及进行食管胃十二指肠镜检查和活检。在手术前及术后不少于12个月对患者健康状况进行主观和客观评估。如果术后疾病症状仍然存在或出现新的症状（即胸骨后疼痛、吞咽困难等），则怀疑疝复发。在咨询门诊进行钡剂造影对食管胃的放射学检查，以及食管胃十二指肠镜检查和活检。进行这两项检查后确认疝复发。在分析结果时，将患者分为两组：第1组——小食管裂孔疝患者（根据放射学分类为1级和2级疝），第2组——大食管裂孔疝患者（根据放射学分类为3级和4级疝）。
共有272例（71.4%）患者为小食管裂孔疝，109例（28.6%）患者为大食管裂孔疝。第1组有7例（2.58%）患者被诊断为疝复发，而第2组有11例（10.1%）患者疝复发（P<0.05）。287例（75.4%）患者接受了腹腔镜nissen胃底折叠术，术后有14例（4.98%）患者疝复发，而94例（24.6%）患者接受了Toupet胃底折叠术，术后有4例（4.3%）患者疝复发（P>0.05）。
大疝（根据放射学分类为3级和4级）患者腹腔镜胃底折叠术后食管裂孔疝的复发率显著更高。手术技术（nissen或Toupet胃底折叠术）不是影响食管裂孔疝复发率的重要因素。
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