Oleynikov Dmitry, Jolley Jennifer M
Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE 68198-6245, USA.
Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE 68198-6245, USA.
Surg Clin North Am. 2015 Jun;95(3):555-65. doi: 10.1016/j.suc.2015.02.008.
The treatment of PEHs is challenging. They tend to occur in patients in their 60s and 70s with multiple medical problems and a variety of associated symptoms. Detailed preoperative evaluation is crucial to determining a safe and effective strategy for repair in the operating room. Laparoscopic PEH repair has shown to be advantageous compared with conventional open repair with regard to hospital stay, recovery time, and decreased complications. Although some results indicate there are higher recurrence rates in laparoscopic PEH repair, the clinical significance of these recurrences has not yet been determined. In order to maximize the efficacy of this procedure, modifications have emerged, such as performing a fundoplication and using an absorbable mesh onlay to reinforce the cruroplasty. Althoughmoreprospective, randomized studies are needed to support the superior results of these surgical adjuncts, laparoscopic PEH repair with an antireflux procedure and absorbable mesh should be the current standard of care.
PEH的治疗具有挑战性。它们往往发生在60多岁和70多岁有多种医疗问题及各种相关症状的患者中。详细的术前评估对于确定手术室中安全有效的修复策略至关重要。与传统开放修复相比，腹腔镜PEH修复在住院时间、恢复时间和并发症减少方面已显示出优势。尽管一些结果表明腹腔镜PEH修复的复发率较高，但这些复发的临床意义尚未确定。为了使该手术的疗效最大化，已经出现了一些改进方法，如进行胃底折叠术和使用可吸收补片覆盖来加强盆底修复术。尽管需要更多前瞻性、随机研究来支持这些手术辅助手段的更好效果，但采用抗反流手术和可吸收补片的腹腔镜PEH修复应成为当前的标准治疗方法。
