Esophageal and Gastric Cancer Program, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, Mail Route 39602, 800E. 28th Street, Minneapolis, MN 55407, USA.
Surg Endosc. 2011 May;25(5):1526-30. doi: 10.1007/s00464-010-1429-8. Epub 2010 Oct 26.
Transhiatal robot-assisted total esophagectomy (RE) has gained acceptance as a minimally invasive procedure with several clinical benefits. In this report, the authors describe their experience with the incidence of incarcerated hiatal hernia after RE.
Between March 2007 and July 2009, 36 patients underwent RE at the authors' institution. A retrospective chart review was performed, and data were abstracted including gender, age, weight at surgery, presenting symptoms, pathologic diagnosis, operative time, estimated blood loss, mortality, and postoperative complications.
The study cohort consisted of 28 men and 8 women undergoing RE. Their average age was 65.4±10.5 years, and their mean body weight was 86.2±24.8 kg at surgery. A review of medical records indicated that 7 (19.4%) of the 36 patients had postoperative incarcerated hiatal hernias. Two of these patients had experienced two episodes of incarceration, which required reoperation. One patient died of complications related to hernia repair. Six (85.7%) of 7 patients had a preexisting diagnosis of hiatus hernia which was significantly higher in comparison to the incidence of this complication within the group of 29 patients without post-operative hernia incarcerations (11 of 29, 37.9%; Fisher's exact p=0.04).
The results indicate that postoperative incarcerated hiatal hernia after RE is an infrequently reported, albeit serious, complication. A preexisting hiatal hernia may put patients at a higher risk of incarceration. According to the authors' experience, a primary closure and reinforcement with mesh sutured to the gastric wall is recommended as a preventive measure. Diligent follow-up evaluation with regular computed tomography (CT) scans investigating likelihoods for incarceration is advisable, especially for patients with preexisting hernias.
经食管裂孔机器人辅助全胃切除术（RE）作为一种具有多种临床优势的微创手术方法已被广泛接受。在本报告中，作者描述了他们在 RE 后发生嵌顿性食管裂孔疝的经验。
2007 年 3 月至 2009 年 7 月，作者所在机构的 36 名患者接受了 RE。对病历进行回顾性分析，提取的资料包括性别、年龄、手术时体重、主要症状、病理诊断、手术时间、估计失血量、死亡率和术后并发症。
研究队列包括 28 名男性和 8 名女性，平均年龄为 65.4±10.5 岁，手术时平均体重为 86.2±24.8kg。对病历的回顾显示，36 例患者中有 7 例（19.4%）术后发生嵌顿性食管裂孔疝。其中 2 例发生过两次嵌顿，需要再次手术。1 例患者死于与疝修补相关的并发症。7 例（85.7%）患者有术前诊断为食管裂孔疝，这一比例明显高于无术后疝嵌顿的 29 例患者（11 例，37.9%；Fisher 确切概率 p=0.04）。
RE 后发生的嵌顿性食管裂孔疝是一种罕见但严重的并发症。存在食管裂孔疝可能使患者发生嵌顿的风险更高。根据作者的经验，建议采用胃壁缝合网片的一期关闭和加固作为预防措施。对有食管裂孔疝病史的患者，应进行定期 CT 随访评估，以发现嵌顿的可能性。
