Kovács Balázs, Orosz Mikolt, Csucska Máté, Singhal Saurabh, Juhász Árpád, Lóderer Zoltán
Department of Vascular, Plastic and General Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary.
Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Case Rep Surg. 2018 May 8;2018:9069430. doi: 10.1155/2018/9069430. eCollection 2018.
Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs.
A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm) and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. "U" figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted.
No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement.
Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.
巨大食管裂孔疝的非加强性拉伸修复易复发，网状移植物植入的作用仍存在争议。在不使用高成本生物同种异体移植物的情况下创造一种新的可行选择是很有必要的。本研究介绍了真皮移植物加强术的应用，这是一种经济高效、易于应用的替代方法，用于巨大食管裂孔疝修复的移植物加强。
选择一名62岁复发性巨大食管裂孔疝（9×11厘米）且胃翻转的女性患者，该患者在另一个科室完成贝尔西修复术后立即接受试点手术。通过腹腔镜方法对膈肌脚进行标准的三针不可吸收重建。从腹部松弛皮肤获取一块12×6厘米的自体真皮移植物。用钛钉固定在膈肌闭合处进行“U”形覆盖加强。手术以标准的多尔胃底折叠术完成。进行了1个月和7个月的随访。
未观察到术后短期并发症。1个月随访时，计算机断层扫描成像显示腹部脏器解剖位置正常。高分辨率测压显示食管下括约肌压力正常。术前的腹部不适症状得到缓解。手术成本低于网状移植物加强后的平均成本。
真皮移植物加强术在巨大食管裂孔疝修复中是一种廉价、易于应用的手术方法，即使在腹腔镜再次手术的情况下也是如此。
