Division of Minimally Invasive Surgery, Legacy Health System, Portland, OR 97210, USA.
J Gastrointest Surg. 2011 Oct;15(10):1743-9. doi: 10.1007/s11605-011-1596-5. Epub 2011 Jul 20.
Laparoscopic techniques have led to hiatal procedures being performed with less morbidity but higher failure rates. Biologic mesh (biomesh) has been proposed as an alternative to plastic mesh to achieve durable repairs while minimizing stricturing and erosion. This paper documents the lack of significant dysphagia after the placement of biomesh during hiatal hernia repair.
A retrospective chart review of patients who underwent paraesophageal hiatal hernia repairs with and without biomesh was performed. Hernias were diagnosed with esophagogastroscopy and esophageal manometry. Demographic, procedural, and pre- and post-surgery symptom data were recorded.
Fifty-six patients underwent biomesh repair while 33 patients underwent non-mesh repairs. The procedure time for mesh repairs was significantly longer (p = 0.004). Hospital stays, resting lower esophageal sphincter pressure, and mean contraction amplitudes were similar between groups. Residual pressure was measured to be significantly higher in patients who had mesh repairs (p = 0.0001). Normal esophageal peristalsis was maintained in both groups. At first follow-up, mesh patients complained of more dysphagia and bloating, but non-mesh patients had more heartburn. At second follow-up, non-mesh patients had more symptom complaints than mesh patients.
The addition of biomesh for hiatal hernia repair does not result in significantly increased patient dysphagia rates postoperatively compared with patients who underwent primary repair.
腹腔镜技术的应用使得食管裂孔疝手术的发病率降低，但失败率更高。生物网片（biomesh）已被提议作为塑料网片的替代品，以实现持久的修复，同时最小化狭窄和侵蚀。本文记录了在食管裂孔疝修补术中放置生物网片后，明显吞咽困难的发生率较低。
对接受食管裂孔旁疝修补术的患者进行了回顾性图表分析，其中一些患者使用了生物网片，另一些则未使用。通过食管胃十二指肠镜和食管测压来诊断疝。记录患者的人口统计学、手术程序以及手术前后的症状数据。
56 名患者接受了生物网片修复，33 名患者接受了非网片修复。网片修复的手术时间明显更长（p=0.004）。两组的住院时间、静息下食管括约肌压力和平均收缩幅度相似。网片修复患者的残余压力明显更高（p=0.0001）。两组患者的食管蠕动功能均正常。初次随访时，网片组患者抱怨吞咽困难和腹胀的情况更多，但非网片组患者的烧心症状更多。在第二次随访时，非网片组患者的症状抱怨比网片组患者更多。
与接受初次修复的患者相比，在食管裂孔疝修补术中添加生物网片并不会导致术后患者吞咽困难的发生率显著增加。
