腹腔镜胃底折叠术治疗一例腹裂修补术后食管裂孔疝
Laparoscopic fundoplication for a case of esophageal hiatal hernia after gastroschisis repair.
作者信息
Hirose Ryuichiro, Obata Satoshi, Tojigamori Manabu, Nakamura Masatoshi, Taguchi Shohei, Arima Toru
机构信息
Department of Pediatric Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kitakyushu, 802-0077, Japan.
Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.
出版信息
Surg Case Rep. 2019 Nov 4;5(1):167. doi: 10.1186/s40792-019-0725-3.
BACKGROUND
Esophageal hiatal hernia and gastroesophageal reflux have been recognized as inevitable complications after the definitive gastroschisis operation. Patients with refractory gastroesophageal reflux require anti-reflux surgery; however, the surgical adhesions may complicate subsequent surgical therapy, especially in the cases treated by staged repair.
CASE PRESENTATION
A male infant who showed a severe gastroesophageal reflux due to hiatal hernia after staged abdominal fascial closure of gastroschisis. In spite of continuous conservative management, frequent vomiting and hematemesis had become progressively worse at the age of 8 months. Laparoscopic Nissen fundoplication was attempted and completed with no adverse events.
CONCLUSIONS
Laparoscopic fundoplication may be applied, as a first-line approach, for the treatment of gastroesophageal reflux in this difficult group of patients, after the repair of congenital abdominal wall defect.
背景
食管裂孔疝和胃食管反流已被公认为腹裂修补术后不可避免的并发症。难治性胃食管反流患者需要进行抗反流手术；然而，手术粘连可能会使后续手术治疗复杂化，尤其是在分期修补的病例中。
病例报告
一名男婴在分期关闭腹裂的腹部筋膜后，因裂孔疝出现严重胃食管反流。尽管持续进行保守治疗，但在8个月大时，频繁呕吐和呕血情况逐渐恶化。尝试并成功完成了腹腔镜下尼氏胃底折叠术，未发生不良事件。
结论
对于这类困难的患者群体，在修复先天性腹壁缺损后，腹腔镜胃底折叠术可作为治疗胃食管反流的一线方法。
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