Rendón-Medina Marco Aurelio, Ávalos-Abreu Rodolfo Omar, Saucedo-Saldivar Jocelyn, Sánchez-Tellez Erick, Garcia-Puig Marco
General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico.
General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico.
Int J Surg Case Rep. 2018;44:98-102. doi: 10.1016/j.ijscr.2017.07.042. Epub 2017 Jul 25.
A Giant Hiatal Paraesophageal Hernia (GPEH) is a Hiatal Hernia (HH) that includes more than 30% of the stomach in the thorax. The gold standard form of repair today is the laparoscopic abdominal approach in elective scenarios. Laparoscopic HH repair advantages include, less postoperative pain, small incisions, reduced postoperative respiratory complications are reduced, shorter hospital stay. The objective of this paper is to describe a patient undergoing with upper intestinal obstruction and a GPEH Type IV, approached laparoscopically.
We received a female patient 59 years old, she came with symptoms abdominal pain, emesis of intestinal characteristics and obstipation, with an evolution of 5 days. She also referred dyspnea; she went to another institution where made a CAT scan finding a GPEH. We decided to realize the procedure laparoscopically. We follow the principal objectives, reducing the hernia, dissecting al de hernia sac excision, Hiatal reparation with no mesh, and Nissen type fundoplication without Collis Gastroplasty. The patient stayed for seven days for surveillance and when the leukocyte and LDH went to a regular rate patient was discharged. With no complications with normal intestinal function and nearly no pain.
We present a GPEH case associated with upper intestinal obstruction, with clinical findings that suggested ischemia. The approach of the treatment was abdominal laparoscopy.
In elective patients Laparoscopy is superior than abdominal approach. Randomized trials comparing laparoscopic versus open approach are needed to conclude that laparoscopic approach is superior to open approach, in potentially GPEH complicated patients.
巨大食管裂孔旁疝（GPEH）是一种食管裂孔疝（HH），胸腔内包含超过30%的胃。目前修复的金标准术式是在择期情况下采用腹腔镜经腹入路。腹腔镜HH修复术的优点包括术后疼痛减轻、切口小、术后呼吸并发症减少、住院时间缩短。本文的目的是描述一名接受腹腔镜治疗的患有上肠梗阻和IV型GPEH的患者。
我们接诊了一名59岁的女性患者，她因腹痛、具有肠梗阻特征的呕吐和便秘症状前来就诊，病程已有5天。她还自述有呼吸困难；她前往另一家机构，在那里进行了CT扫描，发现患有GPEH。我们决定采用腹腔镜手术。我们遵循主要目标，还纳疝内容物，游离并切除疝囊，不使用补片进行食管裂孔修复，以及进行无科利斯胃成形术的nissen型胃底折叠术。患者住院观察了7天，当白细胞和乳酸脱氢酶恢复正常时出院。无并发症，肠道功能正常，几乎无疼痛。
我们呈现了一例与上肠梗阻相关的GPEH病例，其临床表现提示有缺血情况。治疗方法为经腹腹腔镜手术。
在择期患者中，腹腔镜手术优于开腹手术。需要进行比较腹腔镜与开腹手术的随机试验，以得出在可能患有复杂GPEH的患者中，腹腔镜手术优于开腹手术的结论。
