Department of Surgery, Northampton General Hospital, UK.
Surgeon. 2011 Apr;9(2):104-11. doi: 10.1016/j.surge.2010.10.010. Epub 2010 Dec 3.
Paraoesophageal hiatus herniae repair can represent a formidable challenge. Afflicted patients tend to be elderly with multiple infirmities often with cardio-pulmonary dysfunction. They may present acutely with protracted vomiting and concurrent biochemical imbalances and it is a technically demanding procedure. There are several debated issues regarding operative technique. This paper will attempt to explain the nature of paraoesophageal hiatus herniae and reviews the recommended pre-operative investigations and operative strategies available.
A literature search was performed from Pubmed and suitable clinical papers were selected for review. When attempting to address whether meshes should be included routinely, electronic searches were performed in PubMed, Embase and the Cochrane library. A systematic search was done with the following medical subject heading (MeSH) terms: 'paraoesophageal hernia repair' AND 'mesh'. In PubMed and Embase the search was carried out with the limits 'humans', 'English language', 'all adult: 19+ years' and 'published between 1990 and 2010'. A manual cross-reference search of the bibliographies of included papers was carried out to identify additional potentially relevant studies.
Firm conclusions are difficult to draw due to the diverse nature of both the disorder and the presentation however principals of management can be suggested. Similarly, there is no conclusive proof of the most effective operative technique and therefore the options are described.
Due to the relative lack of cases encountered at smaller institutions, there is a good argument for centralisation of these cases into regional centres to allow research and facilitate improvements in care.
食管裂孔疝修补术可能是一项艰巨的挑战。患病患者往往年龄较大，伴有多种疾病，常伴有心肺功能障碍。他们可能会出现持续性呕吐和伴随的生化失衡，并伴有急性症状，这是一项技术要求很高的手术。手术技术存在几个有争议的问题。本文将试图解释食管裂孔疝的性质，并回顾推荐的术前检查和现有的手术策略。
从 Pubmed 进行文献检索，并选择合适的临床论文进行综述。当试图确定是否应常规包括网片时，在 PubMed、Embase 和 Cochrane 图书馆中进行了电子搜索。使用以下医学主题词(MeSH)进行系统搜索：“食管裂孔疝修补术”和“网片”。在 PubMed 和 Embase 中，搜索限制为“人类”、“英语”、“所有成人：19 岁及以上”和“发表于 1990 年至 2010 年之间”。对纳入文献的参考文献进行手动交叉引用搜索，以确定其他潜在相关研究。
由于疾病和表现的多样性，很难得出确凿的结论，但可以提出管理原则。同样，也没有最有效的手术技术的明确证据，因此描述了各种选择。
由于在较小的医疗机构中遇到的病例相对较少，因此有充分的理由将这些病例集中到区域中心，以进行研究并促进护理的改善。
