Braghetto Italo, Korn Owen, Rojas Jorge, Valladares Hector, Figueroa Manuel
Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile.
Arq Bras Cir Dig. 2020;33(1):e1489. doi: 10.1590/0102-672020190001e1489. Epub 2020 May 18.
Erosion and migration into the esophagogastric lumen after laparoscopic hiatal hernia repair with mesh placement has been published.
To present surgical maneuvers that seek to diminish the risk of this complication.
We suggest mobilizing the hernia sac from the mediastinum and taking it down to the abdominal position with its blood supply intact in order to rotate it behind and around the abdominal esophagus. The purpose is to cover the on-lay mesh placed in "U" fashion to reinforce the crus suture.
We have performed laparoscopic hiatal hernia repair in 173 patients (total group). Early postoperative complications were observed in 35 patients (27.1%) and one patient died (0.7%) due to a massive lung thromboembolism. One hundred twenty-nine patients were followed-up for a mean of 41+28months. Mesh placement was performed in 79 of these patients. The remnant sac was rotated behind the esophagus in order to cover the mesh surface. In this group, late complications were observed in five patients (2.9%). We have not observed mesh erosion or migration to the esophagogastric lumen.
The proposed technique should be useful for preventing erosion and migration into the esophagus.
腹腔镜食管裂孔疝修补并放置补片后补片侵蚀及向食管胃腔内移位的情况已有报道。
介绍旨在降低该并发症风险的手术操作方法。
我们建议从纵隔游离疝囊，在保留其血供的情况下将其降至腹腔位置，以便将其旋转至腹段食管后方并围绕腹段食管。目的是覆盖以“U”形放置的补片以加强脚的缝合。
我们对173例患者进行了腹腔镜食管裂孔疝修补术（总组）。35例患者（27.1%）出现早期术后并发症，1例患者（0.7%）因大面积肺血栓栓塞死亡。129例患者接受了平均41±28个月的随访。其中79例患者进行了补片放置。将残余疝囊旋转至食管后方以覆盖补片表面。在该组中，5例患者（2.9%）出现晚期并发症。我们未观察到补片侵蚀或向食管胃腔内移位的情况。
所提出的技术对于预防补片侵蚀及向食管内移位应是有用的。
