使用膀胱基质移植物修复食管旁裂孔疝

Paraesophageal Hiatal Hernia Repair With Urinary Bladder Matrix Graft.

作者信息

Howell Raelina S, Fazzari Melissa, Petrone Patrizio, Barkan Alexander, Hall Keneth, Servide María José, Anduaga María Fernanda, Brathwaite Collin E M

机构信息

Departments of Surgery.

Biostatics, NYU Winthrop Hospital, Mineola, New York.

出版信息

JSLS. 2018 Apr-Jun;22(2). doi: 10.4293/JSLS.2017.00100.

DOI:10.4293/JSLS.2017.00100

PMID:29950797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6002250/

Abstract

BACKGROUND AND OBJECTIVES

Paraesophageal hiatal hernia repair can be performed with or without mesh reinforcement. The use, technique, and mesh type remain controversial because of mixed reports on mesh-related complications. Short-term outcomes have become important in all forms of surgery.

METHODS

From January 2012 through April 2017, all patients who underwent isolated hiatal hernia repair in our center were reviewed. Concomitant bariatric surgery cases were excluded. Repairs reinforced by porcine urinary bladder matrix (UBM) graft were compared to non-UBM repairs. Statistical comparison was based on a Wilcoxon 2-sample test or Fisher's exact test.

RESULTS

We reviewed 239 charts; 110 bariatric cases and 8 cases with non-UBM reinforcement were excluded. We identified 121 patients: 56 UBM-reinforced (46.3%) versus 65 non-UBM (53.7%). Sixteen (28.6%) UBM cases were male versus 23 (35.4%) non-UBM cases. The UBM patients were significantly older (63.9 versus 54.3; = .001). There was no difference in mean BMI (29.6 vs 28.5; = .28). Cases were performed laparoscopically (60.7% vs 67.7%; = .45) or robotically (39.3% vs 32.3%; = .45), with no conversions to open. The UBM group had a longer mean operative time (183 minutes vs 139 minutes; = .001).There was no difference in median length of stay (2 days vs 2 days; = .09) or 30-day readmission rate (7.1% vs 7.5%; =.99). Postoperative complications were graded according to the Clavien-Dindo classification, and there was no difference (19.6% vs 9.2%; = .12).

CONCLUSIONS

Hiatal hernia repair with UBM reinforcement can be performed safely with no increase in postoperative complications.

摘要

背景与目的

食管旁裂孔疝修补术可在有或没有补片加强的情况下进行。由于关于补片相关并发症的报道不一，补片的使用、技术及补片类型仍存在争议。短期疗效在所有手术形式中都变得很重要。

方法

回顾2012年1月至2017年4月期间在本中心接受单纯裂孔疝修补术的所有患者。排除同期行减重手术的病例。将采用猪膀胱基质（UBM）补片加强修补的病例与未采用UBM补片修补的病例进行比较。统计比较基于Wilcoxon双样本检验或Fisher精确检验。

结果

我们回顾了239份病历；排除了110例减重手术病例和8例未采用UBM补片加强修补的病例。我们确定了121例患者：56例采用UBM补片加强修补（46.3%），65例未采用UBM补片修补（53.7%）。16例（28.6%）采用UBM补片修补的患者为男性，23例（35.4%）未采用UBM补片修补的患者为男性。采用UBM补片修补的患者年龄显著更大（63.9岁对54.3岁；P = 0.001）。平均体重指数无差异（29.6对28.5；P = 0.28）。手术通过腹腔镜进行（60.7%对67.7%；P = 0.45）或机器人辅助进行（39.3%对32.3%；P = 0.45），均未转为开放手术。采用UBM补片修补的组平均手术时间更长（183分钟对139分钟；P = 0.001）。中位住院时间无差异（2天对2天；P = 0.09）或30天再入院率无差异（7.1%对7.5%；P = 0.99）。术后并发症根据Clavien-Dindo分类进行分级，无差异（19.6%对9.2%；P = 0.12）。