Bjelovic Milos, Babic Tamara, Spica Bratislav, Gunjic Dragan, Veselinovic Milan, Bascarevic Violeta
University of Belgrade, School of Medicine, Belgrade, Serbia.
Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia.
BMC Surg. 2015 Mar 11;15:22. doi: 10.1186/s12893-015-0008-2.
Even though there is no consensus, many authors believe that in the cases of large hiatal defects, structurally altered crura and/or absence of peritoneal lining, a crural reinforcement should be performed. Reinforcement could be performed with different techniques and different type of mesh, either synthetic or biologic. The disadvantages of mesh repair include the possibility of serious complications and increased costs especially in the usage of composite or biologic mesh.
The study includes 10 cases of reinforced primary suture line of the pillars with autologous fascia lata, in elective laparoscopic repair of the giant PEH with a large hiatal defect and friable crura. After intraopreative confirmation of the large hiatal defect (hiatal surface area of more than 8 cm²) and friable crura, an autologous fascia lata graft was harvested in the usual manner and placed in on-lay fashion to reinforce the pillar suture line. We analyzed surgical technique, complications, and initial follow-up of the patients.
Average hiatal surface area (HSA) in our series was 10.6 cm² (range 8.1 to 14.4 cm²). The average duration of operation was 203.9 min/3.4 hours (range 160-250 min). Except for a mild hematoma in the harvesting region that resolved spontaneously, there were no procedure related complications and 30 days mortality rate was zero. The average postoperative length of stay was 6.5 days (5-8 days). Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit. So far there is no hernia recurrence and/or problems with swallowing function. However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities.
Autologous fascia lata graft hiatal reinforcement represents a technically feasible, easy, and available option for the on-lay reinforcement of large hiatal defects with friable crura in the laparoscopic repair of giant PEHs.
尽管尚无共识，但许多作者认为，在存在巨大裂孔缺损、结构改变的膈脚和/或腹膜衬里缺失的情况下，应进行膈脚加固。加固可采用不同技术和不同类型的补片，包括合成补片或生物补片。补片修补的缺点包括可能出现严重并发症以及成本增加，尤其是在使用复合补片或生物补片时。
本研究纳入10例采用自体阔筋膜对支柱的初次缝合线进行加固的病例，这些病例均为择期腹腔镜下修复巨大食管裂孔疝伴巨大裂孔缺损和脆弱膈脚。术中确认存在巨大裂孔缺损（裂孔表面积超过8 cm²）且膈脚脆弱后，按常规方式获取自体阔筋膜移植物，并采用覆盖法放置以加固支柱缝合线。我们分析了手术技术、并发症及患者的初始随访情况。
我们这组病例的平均裂孔表面积（HSA）为10.6 cm²（范围为8.1至14.4 cm²）。平均手术时长为203.9分钟/3.4小时（范围为160 - 250分钟）。除了取材部位出现的轻度血肿自行消退外，未发生与手术相关的并发症，30天死亡率为零。术后平均住院时长为6.5天（5 - 8天）。10例患者中，5例完成了年度随访，8例完成了6个月的随访。到目前为止，尚无疝复发和/或吞咽功能问题。然而，有1例患者在取材部位感到轻度不适，但不影响正常日常活动。
自体阔筋膜移植物裂孔加固术是腹腔镜修复巨大食管裂孔疝时，对伴有脆弱膈脚的巨大裂孔缺损进行覆盖加固的一种技术上可行、简便且可用的选择。
