Division of Thoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):395-404, 404.e1. doi: 10.1016/j.jtcvs.2009.10.005. Epub 2009 Dec 11.
Laparoscopic repair of giant paraesophageal hernia is a complex operation requiring significant laparoscopic expertise. Our objective was to compare our current approach and outcomes for laparoscopic repair of giant paraesophageal hernia with our previous experience.
A retrospective review of patients undergoing nonemergency laparoscopic repair of giant paraesophageal hernia, stratified by early versus current era (January 1997-June 2003 and July 2003-June 2008), was performed. We evaluated clinical outcomes, barium esophagogram, and quality of life.
Laparoscopic repair of giant paraesophageal hernia was performed in 662 patients (median age 70 years, range 19-92 years) with a median percentage of herniated stomach of 70% (range 30%-100%). With time, use of Collis gastroplasty decreased (86% to 53%), as did crural mesh reinforcement (17% to 12%). Current era patients were 50% more likely to have a Charlson comorbidity index score greater than 3. Thirty-day mortality was 1.7% (11/662). Mortality and complication rates were stable with time, despite increasing comorbid disease in current era. Postoperative gastroesophageal reflux disease health-related quality of life scores were available for 489 patients (30-month median follow-up), with good to excellent results in 90% (438/489). Radiographic recurrence (15.7%) was not associated with symptom recurrence. Reoperation occurred in 3.2% (21/662).
With time, we have obtained significant minimally invasive experience and refined our approach to laparoscopic repair of giant paraesophageal hernia. Perioperative morbidity and mortality remain low, despite increased comorbid disease in the current era. Laparoscopic repair provided excellent patient satisfaction and symptom improvement, even with small radiographic recurrences. Reoperation rates were comparable to the best open series.
腹腔镜巨大食管裂孔疝修补术是一项复杂的手术，需要丰富的腹腔镜专业知识。我们的目的是比较腹腔镜治疗巨大食管裂孔疝的当前方法和结果与我们之前的经验。
回顾性分析 1997 年 1 月至 2003 年 6 月和 2003 年 7 月至 2008 年 6 月期间非紧急腹腔镜治疗巨大食管裂孔疝的患者，分为早期和当前两个时期（早期和当前）。我们评估了临床结果、钡餐食管造影和生活质量。
腹腔镜治疗巨大食管裂孔疝在 662 例患者中进行（中位年龄 70 岁，范围 19-92 岁），疝入胃的中位数百分比为 70%（范围 30%-100%）。随着时间的推移，Collis 胃成形术的使用率（86%降至 53%）和横膈膜网片加固术（17%降至 12%）下降。当前时期的患者中有 50%的人患有 Charlson 合并症指数评分大于 3。30 天死亡率为 1.7%（11/662）。尽管当前时期合并症增多，但死亡率和并发症发生率仍保持稳定。489 例患者（中位随访 30 个月）可获得术后胃食管反流病健康相关生活质量评分，90%（438/489）为良好至极好。放射学复发（15.7%）与症状复发无关。再手术率为 3.2%（21/662）。
随着时间的推移，我们在腹腔镜治疗巨大食管裂孔疝方面获得了丰富的微创经验，并改进了我们的方法。尽管当前时期合并症增多，但围手术期发病率和死亡率仍然较低。腹腔镜治疗提供了极好的患者满意度和症状改善，即使有小的放射学复发。再手术率与最好的开放系列相当。
