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腹腔镜手术治疗复发性食管裂孔疝伴吞咽困难后双侧聚四氟乙烯/乙烯-四氟乙烯共聚物补片的经壁胃迁移:病例报告

Transmural gastric migration of dual-sided PTFE/ePTFEE mesh after laparoscopic surgery for a recurrent hiatal hernia with dysphagia: case report.

作者信息

Acin-Gandara D, Miliani-Molina C, Carneros-Martin Ja, Martinez-Pineiro J, Vega M De, Pereira-Perez F

出版信息

Chirurgia (Bucur). 2014 Jul-Aug;109(4):538-41.

Abstract

Several series have shown that laparoscopic fundoplication is feasible and safe for the treatment of hiatal hernia, although a high recurrence rate of 42% has been published. The use of mesh repair in these hernias has shown fewer recurrences than primary suture with small number of complications reported.Some of these are severe fibrosis within the hiatus, mesh erosion of the intestinal wall, esophageal strictures, mesh migration into the upper gastrointestinal tract and esophageal perforations. We present a case with late erosion and complete transmural gastric migration of the mesh after surgery. In these cases, the patients may require complex surgical intervention.That was not the case in our patient, who did not require further surgery because the mesh migrated completely. It is therefore advisable to use a mesh very selectively for the laparoscopic repair of hiatal hernias, taking into account the surgeon's experience, the anatomy of the hiatus and the symptoms of the patient.

摘要

多个系列研究表明,腹腔镜胃底折叠术治疗食管裂孔疝是可行且安全的,尽管已发表的研究显示其复发率高达42%。在这些疝修补术中使用补片修复的复发率低于单纯缝合,且报道的并发症较少。其中一些并发症包括食管裂孔内严重纤维化、肠壁补片侵蚀、食管狭窄、补片移入上消化道以及食管穿孔。我们报告一例术后补片迟发性侵蚀并完全经壁向胃内移位的病例。在这些病例中,患者可能需要复杂的手术干预。但我们的患者并非如此,由于补片完全移位,无需进一步手术。因此,考虑到外科医生的经验、食管裂孔的解剖结构和患者的症状,在腹腔镜修补食管裂孔疝时非常有必要选择性地使用补片。

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