Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia Governorate, Egypt.
Hernia. 2023 Dec;27(6):1555-1570. doi: 10.1007/s10029-023-02851-7. Epub 2023 Aug 29.
Giant paraesophageal hernia (GPEH) is a challenging problem for surgeons because of its high recurrence rate. This study was conducted to compare the outcomes in type IV vs. type III GPEHs after laparoscopic repair. Other outcomes included peri-operative morbidity and long-term quality of life.
A retrospective analysis of 130 GPEH patients in a period between 2010 and 2019 underwent a tailored laparoscopic repair in our tertiary center with a minimum follow-up of 48 months. Operative steps included hernial sac excision, crural repair, relaxing incisions, and mesh cruroplasty with special indications.
The study enrolled 90 patients with type III and 40 patients with type IV GPEH. Type IV GPEH patients were older, more fragile, and scored worse on ASA classification, aside from having a more challenging surgical technique (wider crura, weaker muscles, increased need for release incisions, and mesh cruroplasty).Type IV GPEHs had a prolonged operative durations, and a higher conversion rate. Additionally, the same group showed increased morbidity, mortality, and re-operation rates. With a mean follow-up of 65 months (range 48-150 months), the incidence of recurrence was 20.7%, with an increased incidence in type IV GPEH (37.5% vs. 13.33% in type III GPEH). Type IV GPEH, low pre-operative albumin, larger crural defect, and low surgeon experience were significant risk factors for recurrence after laparoscopic repair of GPEH.
Type IV GPEH has a higher peri-operative morbidity and recurrence rate; so, a more tailored laparoscopic repair with a high surgeon experience is needed.
巨大食管裂孔疝（GPEH）因其高复发率，对外科医生来说是一个具有挑战性的问题。本研究旨在比较腹腔镜修补术后 IV 型与 III 型 GPEH 的结果。其他结果包括围手术期发病率和长期生活质量。
对 2010 年至 2019 年期间在我们的三级中心接受定制腹腔镜修复的 130 例 GPEH 患者进行回顾性分析，随访时间至少为 48 个月。手术步骤包括疝囊切除、裂孔修复、松弛切口和带有特殊指征的网片成型。
本研究纳入了 90 例 III 型和 40 例 IV 型 GPEH 患者。IV 型 GPEH 患者年龄较大、身体较脆弱、ASA 分级较差，除了手术技术更具挑战性（更宽的裂孔、更弱的肌肉、增加释放切口的需求和网片成型）外。IV 型 GPEH 的手术时间延长，转换率更高。此外，该组的发病率、死亡率和再次手术率也增加。平均随访 65 个月（范围 48-150 个月），复发率为 20.7%，IV 型 GPEH 的复发率增加（37.5% vs. III 型 GPEH 的 13.33%）。IV 型 GPEH、术前白蛋白水平低、裂孔较大、外科医生经验低是 GPEH 腹腔镜修补术后复发的显著危险因素。
IV 型 GPEH 围手术期发病率和复发率较高；因此，需要更具针对性的腹腔镜修复，并由经验丰富的外科医生进行操作。
