Watkins Jeffrey R, Truitt Michael S, Osman Houssam, Jeyarajah Rohan D
Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA.
JSLS. 2018 Jan-Mar;22(1). doi: 10.4293/JSLS.2017.00086.
Laparoscopic paraesophageal hernia repair (LPEHR) is the new standard, but the use of mesh is still debated. Biologic mesh has shown great promise, but only the U-shaped onlay has been extensively studied. Postoperative dysphagia has historically been a concern with the use of synthetic keyhole mesh and subsequently slowed its adoption. The purpose of our study was to identify the incidence of postoperative dysphagia in a series of patients who underwent laparoscopic paraesophageal hernia repair with novel placement of keyhole biologic mesh.
Thirty consecutive patients who underwent hernia repair with primary suture cruroplasty and human acellular dermal matrix keyhole mesh reinforcement were reviewed over a 2-year period. All procedures were performed at a single institution. Postoperative symptoms were retrospectively identified. Any postoperative hernia on imaging was defined as radiographic recurrence.
Of the 30 consecutive patients who underwent hernia repair, 3 (10%) had mild preoperative dysphagia. The number remained unchanged after LPEHR with keyhole mesh. Return of mild reflux symptoms occurred in 6 (20%) patients. Repeat imaging was performed in 11 patients (37%) at an average of 8 months with 2 slight recurrences. All hernias were classified on preoperative imaging as large hiatal hernias. There were no postoperative complications.
Laparoscopic paraesophageal hernia repair with biologic keyhole mesh reinforcement has a low recurrence rate and no increase in postoperative dysphagia. The traditional belief that keyhole mesh has a higher incidence of dysphagia was not evident in this series.
腹腔镜食管旁疝修补术（LPEHR）是新标准，但补片的使用仍存在争议。生物补片已显示出巨大潜力，但仅U形覆盖补片得到了广泛研究。术后吞咽困难一直是使用合成锁孔补片的一个问题，这也延缓了其应用。我们研究的目的是确定一系列接受腹腔镜食管旁疝修补术并采用新型锁孔生物补片放置方法的患者术后吞咽困难的发生率。
回顾了连续30例接受疝修补术并采用原发性缝合盆底成形术和人脱细胞真皮基质锁孔补片加强的患者，为期2年。所有手术均在单一机构进行。对术后症状进行回顾性分析。影像学检查发现的任何术后疝均定义为影像学复发。
在连续30例接受疝修补术的患者中，3例（10%）术前有轻度吞咽困难。使用锁孔补片进行LPEHR后，这一数字保持不变。6例（20%）患者出现轻度反流症状复发。11例患者（37%）平均在8个月时进行了重复影像学检查，有2例轻微复发。所有疝在术前影像学检查中均被分类为大型食管裂孔疝。无术后并发症。
采用生物锁孔补片加强的腹腔镜食管旁疝修补术复发率低，术后吞咽困难无增加。在本系列中，传统观念中锁孔补片吞咽困难发生率较高的情况并不明显。
