Department of Cardiothoracic Surgery, Division of Thoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
J Gastrointest Surg. 2012 Feb;16(2):417-26. doi: 10.1007/s11605-011-1690-8. Epub 2011 Dec 9.
Laparoscopic paraesophageal hernia repair continues to be one of the most challenging procedures facing the minimally invasive surgeon.
A thorough understanding of the tenets of the operation and advanced skills in minimally invasive laparoscopy are needed for long-term freedom from symptomatic and anatomic recurrence. These include complete reduction of the hernia sac from the mediastinum back into the abdomen with careful preservation of the integrity of muscle and peritoneal lining of the crura, aggressive and complete mobilization of the esophagus to the level of the inferior pulmonary vein, vagal preservation, clear identification of the gastroesophageal junction to allow accurate assessment of the intraabdominal esophageal length, and use of Collis gastroplasty when esophageal lengthening is required for a tension-free intraabdominal repair. Liberal mobilization of the phrenosplenic and phrenogastric attachments substantially increases the mobility of the left limb of the crura, allowing for a tension-free primary closure in a large percentage of patients.
The following describes our current approach to laparoscopic paraesophageal hernia repair following a decade of refinement in a high-volume center.
腹腔镜食管裂孔疝修补术仍然是微创外科医生面临的最具挑战性的手术之一。
为了长期避免症状和解剖复发，需要彻底了解手术原则和微创腹腔镜技术方面的先进技能。这些原则包括将疝囊从纵隔完全还纳到腹部，小心保护裂孔的肌肉和腹膜内层的完整性，积极彻底地游离食管至下肺静脉水平，保留迷走神经，明确胃食管交界处的位置，以便准确评估腹腔内食管的长度，并在需要进行无张力腹腔内修复时使用 Collis 胃成形术。充分游离膈胃和膈脾附着处可显著增加裂孔左侧支的活动度，使大部分患者能够实现无张力的一期缝合。
以下是我们在高容量中心经过十年的完善后，目前对腹腔镜食管裂孔疝修补术的处理方法。
