Division of General Surgery, The University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
J Gastrointest Surg. 2021 Nov;25(11):2757-2769. doi: 10.1007/s11605-021-04940-3. Epub 2021 Feb 2.
There have been steady innovations in hiatal hernia and anti-reflux surgery. The purpose of this article is to provide a historical perspective on practice-changing innovations in the context a single surgeon experience's over a career.
Patients undergoing anti-reflux surgery or hiatal hernia repair by a single surgeon from 12/1992 to 3/2020 were reviewed.
sex, age, hiatal hernia type, operation type, adjuncts used, and additional procedure performed during index operation. Superimposed on this experience are the practice-changing innovations that occurred over this timeframe.
During the time period, 1200 operations were performed. Distributions: Hernia type: I, 707 (58.9%); II-IV, 325 (27.1%); Recurrent/Failed, 168 (14.0%). Type of operation, including laparoscopic and open: Nissen fundoplication: 889 (74.1%); Toupet fundoplication: 162 (13.5%); Collis-Nissen/Toupet fundoplication: 44 (3.7%); hiatal hernia repair without fundoplication (laparoscopic and open): 38 (3.2%); endoluminal fundoplication: 35 (2.9%); hiatal hernia repair with Heller myotomy/ Dor fundoplication: 10 (0.8%); transthoracic Belsey Mark IV: 2 (0.2%); hiatal hernia repair with magnetic sphincter augmentation: 20 (1.7%). Mesh reinforcement: 185 (15.4%). Additional procedures, 210 (17.5%). During this time, these practice-changing innovations occurred: laparoscopic surgery, 48-h pH monitoring, high-resolution manometry, tailoring of fundoplication, energy sources for tissue division and hemostasis, pyloroplasty for symptomatic gastroparesis, the rise and fall of endoluminal therapies, mesh reinforcement, abandonment of short gastric vessel division, and magnetic sphincter augmentation.
Over the last 27 years, a number of practice-changing advances have been made. These have led to changes in technique and operation selection of anti-reflux and hiatal hernia surgery.
食管裂孔疝和抗反流手术领域不断有创新。本文旨在从一名外科医生职业生涯的角度，提供一个关于改变实践的创新的历史视角。
回顾了 1992 年 12 月至 2020 年 3 月期间，由同一位外科医生进行的抗反流手术或食管裂孔疝修补术的患者。
患者的性别、年龄、食管裂孔疝类型、手术类型、使用的辅助手段以及索引手术中进行的其他手术。在此经验之上，叠加了在此期间发生的改变实践的创新。
在此期间，共进行了 1200 例手术。疝类型分布：I 型 707 例（58.9%）；II-IV 型 325 例（27.1%）；复发/失败 168 例（14.0%）。手术类型，包括腹腔镜和开放手术：Nissen 胃底折叠术 889 例（74.1%）；Toupet 胃底折叠术 162 例（13.5%）；Collis-Nissen/Toupet 胃底折叠术 44 例（3.7%）；无胃底折叠的食管裂孔疝修补术（腹腔镜和开放）38 例（3.2%）；内镜下胃底折叠术 35 例（2.9%）；食管裂孔疝修补术联合 Heller 肌切开术/ Dor 胃底折叠术 10 例（0.8%）；经胸 Belsey Mark IV 术 2 例（0.2%）；食管裂孔疝修补术联合磁括约肌增强术 20 例（1.7%）。网片加固术 185 例（15.4%）。其他手术 210 例（17.5%）。在此期间，出现了以下改变实践的创新：腹腔镜手术、48 小时 pH 监测、高分辨率测压、胃底折叠术的定制、组织切割和止血的能源、症状性胃轻瘫的幽门成形术、内镜治疗的兴衰、网片加固术、放弃胃短血管分离术、磁括约肌增强术。
在过去的 27 年中，已经取得了许多改变实践的进展。这些进展导致了抗反流和食管裂孔疝手术技术和手术选择的改变。
