Sawyer Michael A J
Department of Surgery, Oklahoma State University, Comanche County Memorial Hospital, Lawton, Oklahoma, USA.
JSLS. 2018 Oct-Dec;22(4). doi: 10.4293/JSLS.2018.00057.
Biologic and resorbable synthetic materials are used commonly for crural repair reinforcement during laparoscopic hiatal herniorrhaphy. Recently, an ovine polymer-reinforced bioscaffold (OPRBS) has been developed for reinforcement of abdominal wall and hiatal herniorrhaphies. This is the first reported series on use of OPRBS in hiatal hernia repairs.
A retrospective chart review was conducted for consecutive series of patients (n = 25) undergoing laparoscopic or open hiatal herniorrhaphy between August 2016 and May 2017. Data collected included demographics, comorbidities and symptoms, details of operation, complications, and postoperative followup.
Laparoscopic repair was completed in 23 of 24 patients. Reinforcement with OPRBS was accomplished in all cases. Fundoplication was constructed in 24 of 25 patients (96%). Mean followup was 14.2 months. Good-to-excellent symptom control or resolution has been achieved for heartburn (95%), dysphagia (94.7%), regurgitation (100%), nausea and vomiting (100%), dyspnea (100%), and chest pain or discomfort (85.7%). Postoperative esophagogastroduodenoscopy with dilation resulted in resolution of persistent postoperative dysphagia in two patients (8%). To date there have been no clinical recurrences of hiatal hernia.
OPRBS in hiatal hernia repair have been associated with excellent early patient outcomes in this study. OPRBS represent a new paradigm in hernia repair, as it is the first clinically available biological repair material reinforced with embroidered resorbable or permanent synthetic polymer. Relative weaknesses of the current study include the small sample size (n = 25), and short-term (mean = 14.2 months) followup. Long-term followup and additional studies will be required to confirm these findings.
生物材料和可吸收合成材料常用于腹腔镜食管裂孔疝修补术中的腿部修复加固。最近，一种羊聚合物增强生物支架（OPRBS）已被开发用于腹壁和食管裂孔疝修补。这是首次报道使用OPRBS进行食管裂孔疝修补的系列研究。
对2016年8月至2017年5月期间连续接受腹腔镜或开放食管裂孔疝修补术的患者系列（n = 25）进行回顾性病历审查。收集的数据包括人口统计学、合并症和症状、手术细节、并发症以及术后随访情况。
24例患者中有23例完成了腹腔镜修复。所有病例均使用OPRBS进行了加固。25例患者中有24例（96%）进行了胃底折叠术。平均随访时间为14.2个月。烧心（95%）、吞咽困难（94.7%）、反流（100%）、恶心和呕吐（100%）、呼吸困难（100%）以及胸痛或不适（85.7%）的症状控制或缓解情况良好至优秀。术后食管胃十二指肠镜检查及扩张使两名患者（8%）持续存在的术后吞咽困难得到缓解。迄今为止，食管裂孔疝尚无临床复发情况。
本研究中，OPRBS用于食管裂孔疝修补与患者早期良好预后相关。OPRBS代表了疝修补的一种新范式，因为它是第一种临床上可用的用可吸收或永久性合成聚合物刺绣增强的生物修复材料。本研究的相对不足之处包括样本量小（n = 25）以及随访时间短（平均 = 14.2个月）。需要进行长期随访和更多研究来证实这些发现。
