St Peter Shawn D, Ostlie Daniel J, Holcomb George W
Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
J Pediatr Surg. 2007 Jul;42(7):1298-301. doi: 10.1016/j.jpedsurg.2007.03.040.
There are a number of reports in the literature describing the need for a redo fundoplication in patients who have previously undergone open fundoplication. However, these data are not well characterized in our current era of laparoscopic surgery. The purpose of this report is to document the management of patients requiring a redo fundoplication who originally underwent a laparoscopic Nissen fundoplication.
After internal review board approval, the senior surgeon performed a retrospective chart review on all patients undergoing laparoscopic fundoplication between January 2000 and April 2006. Data collected included the patient's age, sex, neurologic impairment, need for gastrostomy, time interval between the initial and redo fundoplication, operative approach for the redo fundoplication, use of a biologic patch for the redo procedure, and length of follow-up.
Two hundred seventy-three patients underwent laparoscopic Nissen fundoplication by the senior author during this time interval. Twenty-one patients have required a redo fundoplication and repair of the enlarged hiatus after laparoscopic fundoplication. No patient has undergone a redo procedure without the development of transmigration of the fundoplication wrap. A redo operation was performed without mesh in 13 patients, of which there were 4 recurrences (31%). The other 8 cases were repaired with Surgisis (Cook, Inc, Bloomington, Ind), and none of these have recurred, with a minimum of 11 months' follow-up and a mean follow-up of 26 months. In the 4 patients requiring a second redo procedure, the enlarged esophageal hiatus was reinforced with Surgisis, and none of these cases have recurred, with a minimum of 3 years' follow-up.
Our data support the use of a biosynthetic mesh to reinforce the crural closure during the repair of iatrogenic hiatal hernias in children.
文献中有多篇报道描述了曾接受开放性胃底折叠术的患者需要再次行胃底折叠术的情况。然而，在我们当前的腹腔镜手术时代，这些数据并未得到很好的描述。本报告的目的是记录最初接受腹腔镜尼氏胃底折叠术且需要再次行胃底折叠术的患者的治疗情况。
经内部审查委员会批准后，资深外科医生对2000年1月至2006年4月期间所有接受腹腔镜胃底折叠术的患者进行了回顾性病历审查。收集的数据包括患者的年龄、性别、神经功能障碍、是否需要胃造口术、初次和再次胃底折叠术之间的时间间隔、再次胃底折叠术的手术方式、再次手术中是否使用生物补片以及随访时间。
在此期间，资深作者为273例患者实施了腹腔镜尼氏胃底折叠术。21例患者在腹腔镜胃底折叠术后需要再次行胃底折叠术并修复扩大的食管裂孔。没有患者在胃底折叠包埋未出现移位的情况下接受再次手术。13例患者在再次手术时未使用补片，其中4例复发（31%）。另外8例使用Surgisis（库克公司，印第安纳州布卢明顿）进行修复，在至少11个月的随访期内，平均随访26个月，均未复发。在4例需要第二次再次手术的患者中，使用Surgisis加强扩大的食管裂孔，在至少3年的随访期内，这些病例均未复发。
我们的数据支持在儿童医源性食管裂孔疝修补术中使用生物合成补片加强膈肌闭合。
