Lugaresi Marialuisa, Mattioli Benedetta, Daddi Niccolò, Di Simone Massimo Pierluigi, Perrone Ottorino, Mattioli Sandro
Division of Thoracic Surgery, Alma Mater Studiorum, University of Bologna, Bologna, Italy Center for the Study and Research on Diseases of the Oesophagus, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Eur J Cardiothorac Surg. 2016 Apr;49(4):1137-43. doi: 10.1093/ejcts/ezv280. Epub 2015 Sep 16.
Type III-IV hiatal hernia (HH) is associated with a true short oesophagus in more than 50% of cases; dedicated treatment of this condition might be appropriate to reduce the recurrence rate after surgery. A case series of patients receiving surgery for Type III-IV hernia was examined for short oesophagus, and the results were analysed.
From 1980 to 1994, 60 patients underwent an open surgical approach, and the position of the oesophago-gastric junction was visually localized; from 1995 to 2013, 48 patients underwent a minimally invasive approach, and the oesophago-gastric junction was objectively localized using a laparoscopic-endoscopic method. The patients underwent a timed clinical-instrumental follow-up that included symptoms assessment, barium swallow and endoscopy. The results were considered to be excellent in the absence of symptoms and oesophagitis; good, if symptoms occurred two to four times a month in the absence of oesophagitis; fair, if symptoms occurred two to four times a week in the presence of hyperaemia, oedema and/or microscopic oesophagitis; and poor, if symptoms occurred on a daily basis in the presence of any grade of endoscopic oesophagitis, HH of any size or type, or the need for antireflux medical therapy. The follow-up time was calculated from the time of surgery to the last complete follow-up.
Among the open surgery patients, 78% underwent abdominal fundoplication, 10% the Belsey Mark IV procedure, 8% laparotomic Collis-Nissen fundoplication and 3% the Pearson operation. Among the minimally invasive surgery patients, 44% underwent a laparoscopic floppy Nissen procedure and 56% a left thoracoscopic Collis-laparoscopic Nissen procedure. The postoperative mortality and complication rates were 1.6% (1/60) and 15% for open surgery and 4.1% (2/48) and 12.5% for minimally invasive surgery. A total of 105 patients were followed up for a median period of 96 months. Five relapses occurred after open surgery (5/59, 8%) and two after minimally invasive surgery (2/46, 4%). Among the 105 patients, excellent, good, fair and poor outcomes were observed in 38%, 44%, 9% and 9%, respectively.
These data suggested that the selective treatment of short oesophagus in association with a Type III-IV hernia reduced the anatomical recurrence rate and achieved satisfactory outcomes.
NCT01606449.
Ⅲ - Ⅳ型食管裂孔疝（HH）在超过50%的病例中与真性短食管相关；针对这种情况进行专门治疗可能有助于降低手术后的复发率。对一系列接受Ⅲ - Ⅳ型疝手术的患者进行短食管检查，并分析结果。
1980年至1994年，60例患者接受开放手术，通过肉眼定位食管胃交界的位置；1995年至2013年，48例患者接受微创手术，使用腹腔镜 - 内镜方法客观定位食管胃交界。患者接受定期的临床器械随访，包括症状评估、吞钡检查和内镜检查。如果没有症状和食管炎，结果被认为是优秀的；如果没有食管炎但症状每月出现2 - 4次，结果为良好；如果在有充血、水肿和/或显微镜下食管炎的情况下症状每周出现2 - 4次，结果为中等；如果在有任何程度的内镜下食管炎、任何大小或类型的HH或需要抗反流药物治疗的情况下症状每天出现，结果为差。随访时间从手术时间计算至最后一次完整随访。
在开放手术患者中，78%接受了腹部胃底折叠术，10%接受了Belsey Mark IV手术，8%接受了开腹Collis - Nissen胃底折叠术，3%接受了Pearson手术。在微创手术患者中，44%接受了腹腔镜软性Nissen手术，56%接受了左胸腹腔镜Collis - 腹腔镜Nissen手术。开放手术的术后死亡率和并发症发生率分别为1.6%（1/60）和15%，微创手术分别为4.1%（2/48）和12.5%。总共105例患者接受了中位时间为96个月的随访。开放手术后发生5例复发（5/59，8%），微创术后发生2例复发（2/46，4%）。在105例患者中，优秀、良好、中等和差的结果分别占38%、44%、9%和9%。
这些数据表明，对与Ⅲ - Ⅳ型疝相关的短食管进行选择性治疗可降低解剖学复发率并取得满意的结果。
NCT01606449。
