Lew Pei Shi, Wong Andrew Siang Yih
Department of Surgery, Changi General Hospital, 2 Simei Street #3, Singapore.
Asian J Endosc Surg. 2013 Aug;6(3):231-3. doi: 10.1111/ases.12039.
We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51-year-old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension-free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow-up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension-free primary repair, the use of a composite mesh can provide effective repair of the hernia.
我们报告一例原发性食管旁疝，通过复合补片进行腹腔镜修补。一名51岁女性因呕吐和上腹部疼痛就诊。CT扫描显示巨大食管旁疝伴胸腔内胃扭转。术中，在变薄的左侧膈脚外侧发现膈肌肌肉缺损，与正常食管裂孔不同。缺损环纤维化，难以进行无张力一期修补。采用复合补片进行腹腔镜补片修补，补片覆盖疝囊以防止潜在的食管或胃侵蚀。恢复顺利，患者术后5天出院。后续随访时无症状。腹腔镜修补食管旁疝可安全进行。在存在大的或纤维化缺损而无法进行无张力一期修补的情况下，使用复合补片可有效修补疝。
