Davila Daniel G, Stetler Jamil L, Lin Edward, Davis Steven Scott, Yheulon Christopher G
Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA.
Surg Laparosc Endosc Percutan Tech. 2019 Dec;29(6):534-538. doi: 10.1097/SLE.0000000000000708.
Pulmonary embolism (PE) following laparoscopic paraesophageal hernia repair (PEHR) is rare but occurs at a higher frequency than other laparoscopic procedures. We describe a series of patients who developed PEs after PEHR in hopes of capturing potential risk factors for further study.
Five cases of PE after PEHR were observed between 2017 and 2018. Individual and perioperative risk factors, and postoperative courses were reviewed.
Patients had a mean age of 73 years (range, 59 to 86). All were female. Two patients presented acutely. Three patients underwent revisional surgery. The average procedure duration was 248 minutes (range, 162 to 324). All patients had gastrostomy tubes placed. The diagnosis of PE occurred within 3 to 19 days postoperatively. Four were treated with 3 months of oral anticoagulation; 1 was managed expectantly.
Highly complex cases, marked by revisional status, need for mesh, large hernia size, and percutaneous endoscopic gastrostomy placement are likely at increased risk for PEs. Preoperative venous thromboembolism chemoprophylaxis should be considered in the majority of laparoscopic PEHR patients.
腹腔镜食管旁疝修补术（PEHR）后发生肺栓塞（PE）较为罕见，但发生率高于其他腹腔镜手术。我们描述了一系列在PEHR后发生PE的患者，以期找出潜在危险因素以供进一步研究。
2017年至2018年间观察到5例PEHR后发生PE的病例。回顾了个体及围手术期危险因素和术后病程。
患者平均年龄73岁（范围59至86岁）。均为女性。2例急性发病。3例接受了翻修手术。平均手术时长248分钟（范围162至324分钟）。所有患者均放置了胃造瘘管。PE诊断发生在术后3至19天内。4例接受了3个月的口服抗凝治疗；1例采取观察等待处理。
以翻修状态、需要使用补片、疝囊大以及经皮内镜下胃造瘘置管为特征的高度复杂病例发生PE的风险可能增加。大多数腹腔镜PEHR患者应考虑术前进行静脉血栓栓塞化学预防。
