Antonakis Filimon, Köckerling Ferdinand, Kallinowski Friedrich
Department of General and Visceral Surgery, Asklepios Klinikum Harburg , Hamburg , Germany.
Department of General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau , Berlin , Germany.
Front Surg. 2016 Mar 9;3:16. doi: 10.3389/fsurg.2016.00016. eCollection 2016.
The aim of this observational study is to analyze the results of patients with large hiatal hernia and upside-down stomach after surgical closure with a biological mesh (Permacol(®), Covidien, Neustadt an der Donau, Germany). Biological mesh is used to prevent long-term detrimental effects of artificial meshes and to reduce recurrence rates.
A total of 13 patients with a large hiatal hernia and endothoracic stomach, who underwent surgery between 2010 and 2014, were included. Interviews and upper endoscopy were conducted to determine recurrences, lifestyle restrictions, and current complaints.
After a mean follow-up of 26 ± 18 months (range: 3-58 months), 10 patients (3 men, mean age 73 ± 13, range: 26-81 years) were evaluated. A small recurrent axial hernia was found in one patient postoperatively. Dysphagia was the most common complaint (four cases); while in one case, the problem was solved after endoscopic dilatation. In three cases, bloat and postprandial pain were documented. In one case, an explantation of the mesh was necessary due to mesh migration and painful adhesions. In one further case with gastroparesis, pyloroplasty was performed without success. The data are compared to the available literature. It was found that dysphagia and recurrence rates are unrelated both in biological and in synthetic meshes if the esophagus is encircled. In series preserving the esophagus at least partially uncoated, recurrences after the use of biological meshes relieve dysphagia. After the application of synthetic meshes, dysphagia is aggravated by recurrences.
Recurrence is rare after encircling hiatal hernia repair with the biological mesh Permacol(®). Dysphagia, gas bloat, and intra-abdominal pain are frequent complaints. Despite the small number of patients, it can be concluded that a biological mesh may be an alternative to synthetic meshes to reduce recurrences at least for up to 2 years. Our study demonstrates that local fibrosis and thickening of the mesh can affect the outcome being associated with abdominal discomfort despite a successful repair. The review of the literature indicates comparable results after 2 years with both biologic and synthetic meshes embracing the esophagus. At the same point in time, reconstruction with synthetic and biologic materials differs when the esophagus is not or only partially encircled in the repair. This is important since encircling artificial meshes can erode the esophagus after 5-10 years.
本观察性研究旨在分析使用生物补片（Permacol®，柯惠医疗，德国多瑙河畔新城）手术闭合巨大食管裂孔疝并胃翻转患者的治疗结果。使用生物补片是为了防止人工补片的长期有害影响并降低复发率。
纳入2010年至2014年间接受手术的13例巨大食管裂孔疝合并胸内胃患者。通过访谈和上消化道内镜检查确定复发情况、生活方式限制及当前症状。
平均随访26±18个月（范围：3 - 58个月）后，对10例患者（3例男性，平均年龄73±13岁，范围：26 - 81岁）进行了评估。术后1例患者发现小的复发性轴向疝。吞咽困难是最常见的症状（4例）；其中1例经内镜扩张后问题得到解决。3例记录有腹胀和餐后疼痛。1例因补片移位和疼痛性粘连需要取出补片。另有1例胃轻瘫患者，幽门成形术未成功。将数据与现有文献进行比较。结果发现，如果环绕食管，生物补片和合成补片的吞咽困难和复发率均无关。在至少部分保留食管未被覆盖的系列研究中，使用生物补片后复发可缓解吞咽困难。使用合成补片后，复发会加重吞咽困难。
使用生物补片Permacol®环绕食管裂孔疝修补术后复发罕见。吞咽困难、胃肠胀气和腹痛是常见症状。尽管患者数量较少，但可以得出结论，生物补片可能是合成补片的一种替代选择，至少在2年内可降低复发率。我们的研究表明，尽管修补成功，但局部纤维化和补片增厚可影响结局并导致腹部不适。文献综述表明，环绕食管使用生物补片和合成补片2年后结果相似。同时，当食管在修补中未被或仅部分被环绕时，合成材料和生物材料的重建情况不同。这很重要，因为环绕的人工补片在5 - 10年后可能侵蚀食管。
