Weitzendorfer M, Pfandner R, Antoniou S A, Schwaiger-Hengstschläger C, Emmanuel K, Koch O O
Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
Department of General and Visceral Surgery, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria.
Hernia. 2019 Apr;23(2):397-401. doi: 10.1007/s10029-019-01890-3. Epub 2019 Jan 25.
This study investigates if pledgeted sutures for hiatal closure could be an alternative to mesh for the surgical treatment of large hiatal hernia.
Forty-one patients who underwent laparoscopic 270° Toupet fundoplication with pledgeted sutured crura between September 2014 and April 2017 were evaluated with regard to recurrence of hiatal hernia at 3 months and 1 year after surgery. Indication for pledgets was a hiatal surface area of at least 5.60 cm, or migration of more than 1/3 of the stomach into the thorax or preoperative hernia size > 5 cm. The integrity of repair was assessed using a barium swallow test 3 months and 1 year after surgery.
All operations could be completed laparoscopically with no intraoperative complications. Until study end no complications related to the pledgets have occurred. Forty-four of 50 patients (88.0%) completed the follow-up radiographic examination 3 months (mean 12.7 weeks) after surgery, and 37 patients (74.0%; mean 55.1 weeks) 1 year after surgery. Postoperative recurrence was diagnosed in 3/44 patients (6.8%) at 3 months, and in 4/37 patients (10.8%) at 1 year follow-up. Only one patient was symptomatic, 1 year after surgery (2.7%). All other patients with reherniations were asymptomatic at time of the study.
Utilization of pledgets to reinforce hiatal sutures seems safe and shows a quite low early recurrence rate compared to other methods. Long-term data will allow firm conclusions as to whether pledgeted sutures are an appropriate solution for the treatment of giant hiatal hernias.
本研究探讨用于食管裂孔闭合的带垫片缝线能否替代补片用于大型食管裂孔疝的手术治疗。
对2014年9月至2017年4月间接受腹腔镜270°杜佩特胃底折叠术并使用带垫片缝线缝合食管裂孔的41例患者，在术后3个月和1年评估食管裂孔疝的复发情况。使用带垫片缝线的指征为食管裂孔表面积至少5.60平方厘米，或超过三分之一的胃移入胸腔，或术前疝大小>5厘米。在术后3个月和1年使用吞钡试验评估修复的完整性。
所有手术均能在腹腔镜下完成，无术中并发症。直至研究结束，未发生与带垫片缝线相关的并发症。50例患者中有44例（88.0%）在术后3个月（平均12.7周）完成了随访影像学检查，37例患者（74.0%；平均55.1周）在术后1年完成了随访影像学检查。术后3个月，44例患者中有3例（6.8%）被诊断为复发，1年随访时，37例患者中有4例（10.8%）复发。术后1年只有1例患者有症状（2.7%）。在研究时，所有其他复发疝患者均无症状。
使用带垫片缝线加强食管裂孔缝线似乎是安全的，与其他方法相比早期复发率相当低。长期数据将有助于就带垫片缝线是否是治疗巨大食管裂孔疝的合适解决方案得出确凿结论。
