Rathore Munir A, Bhatti Muhammad I, Andrabi Syed I H, McMurray Arthur H
Department of Surgery, Antrim Area Hospital, Antrim, North Ireland, UK.
Int J Surg. 2008 Oct;6(5):404-8. doi: 10.1016/j.ijsu.2008.06.005. Epub 2008 Jun 27.
The article tries to address the dilemma confronting the repair of paraesophageal hernia (PEH). The case has been made for repair upon diagnosis. The initial results of laparoscopic repair were projected as successful. However, recurrence and reflux have plagued many studies. Whereas adjunct fundoplication is now consistently performed by most surgeons, the basis is uncertain. Recurrence rate is often higher than that reported if only the 'imaged' follow-up patients are considered. Esophageal lengthening is believed to potentially benefit both the hallmark complications. The worldwide experience with laparoscopic esophageal lengthening is scanty (although it was not uncommon in the days of open surgery). Compared to the open repair, the laparoscopic method has a higher recurrence rate, higher major specific complication rate, comparable symptom outcome and a shorter hospital stay.
本文试图解决食管旁疝（PEH）修复所面临的困境。已提出诊断后即行修复的理由。腹腔镜修复的初步结果预计是成功的。然而，复发和反流一直困扰着许多研究。尽管现在大多数外科医生都常规进行附加胃底折叠术，但其依据尚不确定。如果仅考虑“有影像记录”的随访患者，复发率往往高于所报道的。食管延长被认为可能对这两种标志性并发症都有益。全球范围内腹腔镜食管延长的经验很少（尽管在开放手术时代并不罕见）。与开放修复相比，腹腔镜方法的复发率更高、主要特定并发症发生率更高、症状结局相当且住院时间更短。
