Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera Dei Colli "Monaldi Hospital", 80131, Napoli, Italy.
Hernia. 2021 Oct;25(5):1355-1361. doi: 10.1007/s10029-020-02273-9. Epub 2020 Jul 25.
Reinforced prosthetic crural repair is particularly indicated for giant hiatal hernias. The rationale is to reduce the recurrence rate in the long term. The aim of our study is to evaluate the outcomes of laparoscopic giant hiatal hernia repair using a biosynthetic mesh.
We retrospectively analyzed 44 patients who underwent laparoscopic mesh-reinforced hiatal closure and fundoplication using a biosynthetic material. Inclusion criterion was large hiatal defects (> 5 cm). Follow-up was scheduled at 6, 12 and 36 months after surgery.
44 patients (29F) with a mean age of 62 years (range 14-85) and mean of BMI 24.5 kg/m (range 21-29) underwent successful laparoscopic repair. Twenty-six (59.1%) patients had Nissen-Rossetti fundoplication, whereas 18 (40.9%) had Toupet fundoplication. Six-month questionnaire for the evaluation of symptoms was available for 43 patients (97.7%) and for 40 (90.9%) patients at 12 and 36 months. Mean preoperative symptoms score analysis was 1.68 ± 0.73. Mean scores at each follow-up time were significantly improved compared to baseline (p > 0.05). Barium swallow was available in 37 patients (84.1%) at 1 year after surgery. Radiologic recurrence was observed in two patients (4.5%). No patient had symptoms attributable to recurrence or required revisional surgery. There were no mesh-related complications at 3 years follow-up.
The use of biosynthetic mesh for crural reinforcement is associated with a low incidence of mesh-related complications and with a reasonably low recurrence rate (4.5%) at 36 months. However, additional data with longer follow-up are needed to determine long-term safety and efficacy.
增强型假体修复特别适用于巨大的食管裂孔疝。其原理是降低长期复发率。我们的研究目的是评估使用生物合成网片进行腹腔镜巨大食管裂孔疝修补的结果。
我们回顾性分析了 44 例接受腹腔镜生物合成网片加强裂孔闭合和胃底折叠术的患者。纳入标准为巨大裂孔缺陷（> 5cm）。术后 6、12 和 36 个月进行随访。
44 例患者（29 例女性），平均年龄 62 岁（范围 14-85 岁），平均 BMI 24.5kg/m（范围 21-29），成功完成腹腔镜修补。26 例（59.1%）患者行 Nissen-Rossetti 胃底折叠术，18 例（40.9%）行 Toupet 胃底折叠术。43 例（97.7%）患者可获得 6 个月的症状评估问卷，40 例（90.9%）患者可获得 12 个月和 36 个月的问卷。术前平均症状评分分析为 1.68±0.73。与基线相比，各随访时间的平均评分均显著改善（p>0.05）。37 例患者（84.1%）在术后 1 年进行了钡餐检查。有 2 例（4.5%）患者出现放射学复发。无患者出现与复发相关的症状或需要再次手术。在 3 年随访时无网片相关并发症。
生物合成网片用于横膈脚加强与较低的网片相关并发症发生率相关，并且在 36 个月时复发率（4.5%）合理较低。然而，需要更长时间的随访数据来确定长期安全性和疗效。
