Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri.
Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri.
J Surg Res. 2014 Aug;190(2):594-7. doi: 10.1016/j.jss.2014.05.021. Epub 2014 May 14.
Fevers often arise after redo fundoplication with hiatal hernia repair. We reviewed our experience to evaluate the yield of a fever work-up in this population.
We performed a retrospective review of children undergoing redo Nissen fundoplication with hiatal hernia repair between December 2001 and September 2012. Temperatures and fever evaluations of those children receiving a mesh repair were compared with those without mesh. A fever defined as temperature ≥38.4°C.
Fifty one children received 46 laparoscopic, 4 open, and 1 laparoscopic converted to open procedures. Biosynthetic mesh was used in 25 children whereas 26 underwent repair without mesh. A fever occurred in 56% of those repaired with mesh compared with 23.1% without mesh (P = 0.02). A fever evaluation was conducted in 32% of those with mesh compared with 11.5% without mesh (P = 0.52). A urinary tract infection was identified in one child after mesh use and an infection was identified in two children without mesh, one pneumonia and one wound infection (P = 1). In those repaired with mesh, there was no significant difference in maximum temperature.
Fever is common after redo Nissen fundoplication with hiatal hernia repair and occurs more frequently, and with higher temperatures in those with mesh. Fever work-up in these patients is unlikely to yield an infectious source and is attributed to the extensive dissection during the redo procedure.
redo 食管裂孔疝修补术后常出现发热。我们回顾了我们的经验，以评估该人群发热检查的结果。
我们对 2001 年 12 月至 2012 年 9 月期间行 redo Nissen 胃底折叠术加食管裂孔疝修补术的儿童进行了回顾性研究。比较了接受网片修补术和未接受网片修补术的儿童的体温和发热评估结果。发热定义为体温≥38.4°C。
51 名儿童接受了 46 例腹腔镜、4 例开放和 1 例腹腔镜转为开放手术。25 名儿童使用了生物合成网片，而 26 名儿童未使用网片进行修复。与未使用网片的儿童（23.1%）相比，使用网片的儿童发热率为 56%（P=0.02）。与未使用网片的儿童（11.5%）相比，使用网片的儿童发热评估率为 32%（P=0.52）。使用网片后，有 1 名儿童发生尿路感染，未使用网片的儿童中有 2 名儿童发生感染，1 名肺炎，1 名伤口感染（P=1）。在使用网片的儿童中，最高体温无显著差异。
redo 食管裂孔疝修补术后发热常见，且发热更频繁，使用网片的儿童发热温度更高。这些患者的发热检查不太可能发现感染源，这归因于 redo 手术中的广泛解剖。
