Department of Surgery, Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Surg Endosc. 2022 Jul;36(7):5451-5455. doi: 10.1007/s00464-021-08887-z. Epub 2021 Nov 29.
Hiatal hernia recurrence following surgical repair is common. We sought to define the most common anatomic location and mechanism for hiatal failure to inform technical strategies to decrease recurrence rates.
Retrospective chart review and video analysis were performed for all recurrent hiatal hernia operations performed by a single surgeon between January 2013 and April 2020. Hiatal recurrences were defined by anatomic quadrants. Recurrences on both left and right on either the anterior or posterior portion of the hiatus were simply classified as 'anterior' or 'posterior', respectively. Three or more quadrants were defined as circumferential. Mechanism of recurrence was defined as disruption of the previous repair or dilation of the hiatus.
There were 130 patients to meet criteria. Median time to reoperation from previous hiatal repair was 60 months (IQR19.5-132). First-time recurrent repairs accounted for 74%, second time 18%, and three or more previous repairs for 8% of analyzed procedures. Mesh had been placed at the hiatus in a previous operation in 16%. All reoperative cases were completed laparoscopically. Video analysis revealed anterior recurrences were most common (67%), followed by circumferential (29%). There were two with left-anterior recurrence (1.5%), two posterior recurrence (1.5%), and one right-sided recurrence. The mechanism of recurrence was dilation in 74% and disruption in 26%. Disruption as a mechanism was most common in circumferential hiatal failures. Neither the prior number of hiatal surgeries nor the presence of mesh at the time of reoperation correlated with anatomic recurrence location or mechanism. Reoperations in patients with hiatal disruption occurred after a shorter interval when compared to hiatal dilation.
The most common location and mechanism for hiatal hernia recurrence is anterior dilation of the hiatus. Outcomes following techniques designed to reinforce the anterior hiatus and perhaps to prevent hiatal dilation should be explored.
手术修复后的食管裂孔疝复发很常见。我们旨在明确食管裂孔疝失败的最常见解剖位置和机制，为降低复发率提供技术策略。
对 2013 年 1 月至 2020 年 4 月期间由同一位外科医生进行的所有复发性食管裂孔疝手术进行回顾性图表审查和视频分析。通过解剖象限定义食管裂孔疝复发。食管裂孔的前或后部分的左侧和右侧的复发均简单地分别归类为“前”或“后”。三个或更多象限被定义为环状。复发机制定义为先前修复的破裂或食管裂孔的扩张。
符合标准的患者共有 130 例。从上次食管裂孔修补术后到再次手术的中位时间为 60 个月（IQR19.5-132）。初次复发性修复占 74%，第二次占 18%，分析的手术中，三次或以上的修复占 8%。在前一次手术中，在食管裂孔处放置了网片的占 16%。所有再次手术均通过腹腔镜完成。视频分析显示，前侧复发最常见（67%），其次是环状（29%）。有两例左侧前侧复发（1.5%），两例后侧复发（1.5%），一例右侧复发。复发的机制是扩张占 74%，破裂占 26%。破裂作为一种机制在环状食管裂孔疝失败中最为常见。在再次手术时，食管裂孔手术的次数或网片的存在与解剖复发部位或机制均无相关性。与食管裂孔扩张相比，食管裂孔破裂的患者再次手术的时间间隔更短。
食管裂孔疝复发的最常见位置和机制是食管裂孔前侧扩张。应探索旨在加强食管裂孔前侧和可能预防食管裂孔扩张的技术的结果。
