Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milano, Italy.
Hernia. 2022 Apr;26(2):619-626. doi: 10.1007/s10029-020-02188-5. Epub 2020 Apr 25.
Different surgical variations have been described for laparoscopic crural repair however, the technique is not standardized and left to the surgeons' preference.
The purpose of this study is to describe a standardized "patient tailored" approach for laparoscopic posterior cruroplasty in the setting of elective hiatal hernia repair.
Retrospective single-center study was conducted (November 2015 to November 2019). The technical aspects of a standardized "patient tailored" laparoscopic posterior crural repair are described. Perioperative outcomes and patients' quality of life, measured with the disease specific Gastro-Esophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) and generic Short Form-36 (SF-36), were analyzed.
One hundred and forty-one patients were treated for symptomatic hiatal hernia according to the described "patient tailored" concept. Overall, 102 (72.3%) patients underwent simple suture repair while simple suture repair buttressed with biosynthetic resorbable U shaped mesh [Phasix ST-Bard] was used in 39 (27.7%) patients. Toupet fundoplication was fashioned in all patients. The median operative time was 131 min (IQR 55-240). No intraoperative complications or conversion to open surgery occurred. The median postoperative stay was 1.8 days (range 1-7). The overall postoperative complication rate was 4.2%. The median follow-up was 21 months (IQR range 1-34) with 102 patients having a minimum follow-up of 6 months. Recurrent hernia was diagnosed in three patients (2.1%), but none required reoperation. No mesh-related complications occurred. Compared to baseline, the median GERD-HRQL (p = 0.003) and all SF-36 items (p < 0.001) were significantly improved.
The application of a standardized "patient tailored" concept for laparoscopic posterior cruroplasty seems safe and effective in the medium-term follow-up with promising perioperative outcomes and quality of life improvement. This approach may be valuable to assure procedure reproducibility, standardization, and to uniformly interpret the outcomes.
腹腔镜耻骨修复术已有多种手术方式，但该技术尚未标准化，取决于术者的偏好。
本研究旨在描述一种标准化的“个体化”腹腔镜后耻骨成形术方法，用于择期食管裂孔疝修补术。
本研究为回顾性单中心研究（2015 年 11 月至 2019 年 11 月）。描述了一种标准化的“个体化”腹腔镜后耻骨修复技术。分析了围手术期结果和患者生活质量，采用特定于疾病的胃食管反流病健康相关生活质量量表（GERD-HRQL）和通用 36 项简短健康状况调查问卷（SF-36）进行评估。
141 例有症状的食管裂孔疝患者采用描述的“个体化”概念进行治疗。总体而言，102 例（72.3%）患者接受单纯缝合修复，39 例（27.7%）患者接受单纯缝合修复联合生物可吸收 U 形网片[Phasix ST-Bard]加固。所有患者均行 Toupet 胃底折叠术。中位手术时间为 131 分钟（IQR 55-240）。无术中并发症或中转开放手术。中位术后住院时间为 1.8 天（范围 1-7）。总术后并发症发生率为 4.2%。中位随访时间为 21 个月（IQR 范围 1-34），102 例患者的随访时间至少为 6 个月。3 例（2.1%）患者诊断为复发性疝，但均无需再次手术。无网片相关并发症。与基线相比，GERD-HRQL 中位数（p=0.003）和所有 SF-36 项目中位数（p<0.001）均显著改善。
在中期随访中，应用标准化的“个体化”概念进行腹腔镜后耻骨成形术似乎是安全有效的，具有良好的围手术期结果和生活质量改善。这种方法对于确保手术的可重复性、标准化和统一解释结果可能具有重要价值。
