新型“星爆”网片修补食管旁疝和复发性食管裂孔疝的效果：与“钥匙孔”网片修补的比较。
Novel "starburst" mesh configuration for paraesophageal and recurrent hiatal hernia repair: comparison with keyhole mesh configuration.
机构信息
Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA.
出版信息
Surg Endosc. 2023 Mar;37(3):2239-2246. doi: 10.1007/s00464-022-09447-9. Epub 2022 Jul 28.
BACKGROUND
Controversy exists over the use of mesh, its type and configuration in repair of hiatal hernia. We have used biological mesh for large or recurrent hiatal hernias. We have developed a mesh configuration to better enhance the tensile strength of the hiatus by folding the mesh over the edge of the hiatus-entitled the "starburst" configuration. We report our experience with the starburst configuration, comparing it to our results with the keyhole configuration.
METHODS
Medical records of all patients undergoing either the keyhole or starburst mesh configuration hiatal hernia repair were reviewed between 2017 and 2021. Data gathered included age, sex, type of hernia (sliding, paraesophageal, or recurrent), fundoplication type (none, Nissen, Toupet, Dor, Collis-Nissen, Collis-Toupet, or magnetic sphincter augmentation [MSA]), 30-day complications, and long-term outcomes (hiatal hernia recurrence, reflux-symptom recurrence, dysphagia, dilations, reoperations).
RESULTS
From 7/2017 to 8/2019, 51 cases using the keyhole mesh were completed. Sliding hiatal hernia comprised 4%, paraesophageal hernia (PEH) 64% and recurrent hiatal hernia (RHH) 34% of cases. Distribution of fundoplication type: 2% none, 41% Nissen, 41% Toupet, 8% Dor, 2% Collis-Nissen, and 6% Collis-Toupet. 30-day complication rate 31%. Long-term outcomes: recurrent hiatal hernia 16%, dysphagia 12%, dysphagia requiring dilation(s) 10%, recurrent GERD symptoms 4%, and reoperation 14%. From 10/2020 to 8/2021, 58 cases using the starburst configuration were completed. PEH comprised 60% and RHH 40%. Distribution of fundoplication type: 10% none, 40% Nissen, 43% Toupet, 5% MSA, 2% Collis-Toupet. 30-day complication rate 16%. Long-term outcomes: recurrent hiatal hernia 19%, dysphagia 14%, dilations 5%, recurrent GERD symptoms 9%, and reoperations 3%.
CONCLUSION
The starburst mesh configuration compares favorably with the keyhole configuration with respect to postoperative dysphagia, need for esophageal dilation, and GERD symptom recurrence, with similar recurrence rates. We are continuing to further refine this technique and study the long-term outcomes.
背景
在修复食管裂孔疝时，关于使用网片、网片类型和结构存在争议。我们使用生物网片治疗大的或复发性食管裂孔疝。我们开发了一种网片结构，通过将网片折叠在食管裂孔边缘上来更好地增强食管裂孔的拉伸强度，这种结构称为“星爆”结构。我们报告了使用星爆结构的经验，并将其与使用钥匙孔结构的结果进行了比较。
方法
回顾了 2017 年至 2021 年间接受钥匙孔或星爆网片食管裂孔疝修补术的所有患者的病历。收集的数据包括年龄、性别、疝类型（滑动、食管旁或复发性）、胃底折叠术类型（无、Nissen、Toupet、Dor、Collis-Nissen、Collis-Toupet 或磁括约肌增强[MSA]）、30 天并发症和长期结果（食管裂孔疝复发、反流症状复发、吞咽困难、扩张、再次手术）。
结果
从 2017 年 7 月至 2019 年 8 月，完成了 51 例使用钥匙孔网片的手术。滑动性食管裂孔疝占 4%，食管旁疝（PEH）占 64%，复发性食管裂孔疝（RHH）占 34%。胃底折叠术类型分布：无 2%，Nissen 41%，Toupet 41%，Dor 8%，Collis-Nissen 2%，Collis-Toupet 6%。30 天并发症发生率为 31%。长期结果：食管裂孔疝复发 16%，吞咽困难 12%，需要扩张的吞咽困难 10%，复发性 GERD 症状 4%，再次手术 14%。从 2020 年 10 月至 2021 年 8 月，完成了 58 例使用星爆网片的手术。PEH 占 60%，RHH 占 40%。胃底折叠术类型分布：无 10%，Nissen 40%，Toupet 43%，MSA 5%，Collis-Toupet 2%。30 天并发症发生率为 16%。长期结果：食管裂孔疝复发 19%，吞咽困难 14%，扩张 5%，复发性 GERD 症状 9%，再次手术 3%。
结论
与钥匙孔结构相比，星爆网片在术后吞咽困难、需要食管扩张和 GERD 症状复发方面具有优势，且复发率相似。我们正在进一步完善这项技术，并研究长期结果。
Zotero 插件