Hietaniemi Henriikka, Ilonen Ilkka, Järvinen Tommi, Kauppi Juha, Andersson Saana, Sintonen Harri, Räsänen Jari
Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland.
BMC Surg. 2020 May 20;20(1):109. doi: 10.1186/s12893-020-00772-1.
Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life.
All non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life.
The inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%).
Successful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.
计算机断层扫描（CT）广泛应用于巨大食管旁疝（GPEH）的诊断，但尚未系统用于随访。我们进行了一项横断面观察性研究，以评估择期腹腔镜GPEH修补术的中期结果。该研究的主要目的是通过CT评估放射性疝复发率，并确定其与当前症状和生活质量的关联。
从医院病历中识别出2010年至2015年间所有非急诊腹腔镜GPEH修补术病例。为每位患者进行非增强CT检查，并发放针对疾病特异性症状和健康相关生活质量的问卷。
165例患者符合纳入标准（74%为女性，平均年龄67岁）。总复发率为29.3%。CT显示4例（4.3%）患者存在大型复发性疝（>5 cm）。影像学检查结果与症状相关的生活质量无关。围手术期死亡1例（0.6%）。27例患者（16.4%）报告有并发症。
成功的腹腔镜GPEH修补术需要专业知识和经验。它似乎能有效缓解症状，患者满意度高。然而，小的影像学复发很常见，但不影响术后与症状相关的患者健康状况。
