Zaman Jessica A, Lidor Anne O
Department of Surgery, University of Wisconsin, 600 Highland Avenue, CSC K4/744, Madison, WI, 53792, USA.
Curr Gastroenterol Rep. 2016 Oct;18(10):53. doi: 10.1007/s11894-016-0529-6.
While the asymptomatic paraesophageal hernia (PEH) can be observed safely, surgery is indicated for symptomatic hernias. Laparoscopic repair is associated with decreased morbidity and mortality; however, it is associated with a higher rate of radiologic recurrence when compared with the open approach. Though a majority of patients experience good symptomatic relief from laparoscopic repair, strict adherence to good technique is critical to minimize recurrence. The fundamental steps of laparoscopic PEH repair include adequate mediastinal mobilization of the esophagus, tension-free approximation of the diaphragmatic crura, and gastric fundoplication. Collis gastroplasty, mesh reinforcement, use of relaxing incisions, and anterior gastropexy are just a few adjuncts to basic principles that can be utilized and have been widely studied in recent years. In this article, we present a comprehensive review of literature addressing key aspects and controversies regarding the optimal approach to repairing paraesophageal hernias laparoscopically.
虽然无症状的食管旁疝（PEH）可以安全观察，但有症状的疝则需要手术治疗。腹腔镜修补术可降低发病率和死亡率；然而，与开放手术相比，其影像学复发率较高。尽管大多数患者通过腹腔镜修补术症状得到明显缓解，但严格遵循良好的技术对于将复发风险降至最低至关重要。腹腔镜PEH修补术的基本步骤包括充分游离食管纵隔、无张力缝合膈肌脚以及胃底折叠术。科利斯胃成形术、补片加固、使用松弛切口和前胃固定术只是近年来可用于基本原则的一些辅助手段，并且已得到广泛研究。在本文中，我们对关于腹腔镜修补食管旁疝的最佳方法的关键方面和争议进行了全面的文献综述。
