The Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA,
Surg Endosc. 2013 Dec;27(12):4532-8. doi: 10.1007/s00464-013-3107-0. Epub 2013 Aug 16.
Laparoscopic paraesophageal hernia (PEH) repair is associated with an objective recurrence rate exceeding 50% at 5 years. Minimizing tension is a critical factor in preventing hernia recurrence. This study aimed to evaluate the outcomes of crural relaxing incisions in patients undergoing PEH repair.
Records were reviewed to identify patients who received a relaxing incision during laparoscopic PEH repair. The patients were followed by chest X-ray and videoesophagram at 3 months and then annually.
From November 2010 to March 2013, 58 patients underwent PEH repair, and 15 patients received a relaxing incision to accomplish crural closure. The median age of the patients was 72 years (range 58-84 years). The relaxing incision was right-sided in 13 patients, left-sided in one patient, and bilateral in one patient. All the procedures were completed laparoscopically and included a fundoplication. Collis gastroplasty for a short esophagus was performed for 40% of the patients. No major complications occurred. During a median follow-up period of 4 months, one patient had an asymptomatic mildly elevated left hemidiaphragm, and one patient had a trivial recurrent hernia, as shown on esophagogastroduodenoscopy (EGD).
Crural tension likely contributes to the high recurrence rate noted with laparoscopic PEH repair. Relaxing incisions are safe and allow crural approximation. Advanced laparoscopic surgeons should be aware of this option when faced with a large hiatus in a patient with PEH.
腹腔镜食管裂孔疝（PEH）修补术后 5 年内客观复发率超过 50%。减少张力是预防疝复发的关键因素。本研究旨在评估 PEH 修补术中行裂孔旁松弛切口对患者结局的影响。
回顾性分析行腹腔镜 PEH 修补术时行裂孔旁松弛切口的患者的病历资料。术后 3 个月和每年进行胸部 X 线和食管造影检查。
2010 年 11 月至 2013 年 3 月，58 例行 PEH 修补术的患者中，15 例行裂孔旁松弛切口以完成裂孔关闭。患者的中位年龄为 72 岁（范围 58-84 岁）。松弛切口位于右侧 13 例，左侧 1 例，双侧 1 例。所有手术均在腹腔镜下完成，并包括胃底折叠术。40%的患者行 Collis 胃底折叠术治疗短食管。无重大并发症发生。中位随访 4 个月时，1 例无症状性轻度左侧膈肌抬高，1 例轻度复发疝，均经食管胃十二指肠镜检查（EGD）证实。
腹腔镜 PEH 修补术后复发率高，可能与裂孔旁张力有关。裂孔旁松弛切口安全可行，可使裂孔旁紧密贴合。当面对 PEH 患者较大的裂孔时，高级腹腔镜医师应考虑这一选择。
