Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
Department of General, Visceral and Minimally Invasive Surgery, Helios Hospital, Campus 6, 38518, Gifhorn, Germany.
Surg Endosc. 2017 Dec;31(12):5327-5341. doi: 10.1007/s00464-017-5612-z. Epub 2017 Jun 8.
Comparison of elective laparoscopic repair of axial vs paraesophageal hiatal hernias reveals relevant differences in both the patient collectives and the complexity of the procedures.
The present uni- and multivariable analysis of data from the Herniamed Registry compares the outcome for 2047 (67.3%) (type I) axial with 996 (32.7%) (types II-IV) paraesophageal primary hiatal hernias following laparoscopic repair.
Compared with the patients with axial hiatal hernias, patients with paraesophageal hiatal hernia were nine years older, had a higher ASA score (ASA III/IV: 34.8 vs 13.7%; p < 0.001), and more often at least one risk factor (38.8 vs 21.4%; p < 0.001). This led in the univariable analysis to significantly more general postoperative complications (6.0 vs 3.0%; p < 0.001). Reflecting the greater complexity of the procedures used for laparoscopic repair of paraesophageal hiatal hernias, significantly higher intraoperative organ injury rates (3.7 vs 2.3%; p = 0.033) and higher postoperative complication-related reoperation rates (2.1 vs 1.1%; p = 0.032) were identified. Univariable analysis did not reveal any significant differences in the recurrence and pain rates on one-year follow-up. Multivariable analysis did not find any evidence that the use of a mesh had a significant influence on the recurrence rate.
Surgical repair of paraesophageal hiatal hernia calls for an experienced surgeon as well as for corresponding intensive medicine competence because of the higher risks of general and surgical postoperative complications.
对比择期腹腔镜下修复轴型和食管旁裂孔疝，发现两个患者群体和手术复杂性都有显著差异。
本研究对 Herniamed 注册中心的数据进行了单变量和多变量分析，比较了 2047 例（67.3%）（I 型）轴型和 996 例（32.7%）（II-IV 型）食管旁裂孔疝患者的腹腔镜修补术后结果。
与轴型裂孔疝患者相比，食管旁裂孔疝患者的年龄大 9 岁，ASA 评分更高（ASA III/IV：34.8%比 13.7%；p<0.001），且至少有一个危险因素的比例更高（38.8%比 21.4%；p<0.001）。这导致术后总体并发症发生率在单变量分析中显著更高（6.0%比 3.0%；p<0.001）。反映出食管旁裂孔疝腹腔镜修补术的复杂性更高，术中器官损伤率明显更高（3.7%比 2.3%；p=0.033），术后与并发症相关的再次手术率也更高（2.1%比 1.1%；p=0.032）。单变量分析未发现一年随访时复发率和疼痛率有显著差异。多变量分析未发现使用补片对复发率有显著影响。
由于一般和外科术后并发症的风险较高，因此需要有经验的外科医生和相应的重症医学能力来进行食管旁裂孔疝的手术修复。
