Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt.
Updates Surg. 2024 Apr;76(2):555-563. doi: 10.1007/s13304-023-01665-7. Epub 2023 Oct 17.
The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the role of laparoscopy in managing DE patients presenting mainly with gastrointestinal symptoms. We retrospectively reviewed the data of 20 patients who underwent laparoscopic diaphragmatic plication between January 2010 and December 2018. Postoperative outcomes and quality of life were assessed. Most DEs were left sided (95%). Laparoscopic diaphragmatic plication was possible in all patients, along with correcting all associated gastrointestinal and diaphragmatic problems. The former included gastric volvulus (60%), reflux esophagitis (25%), cholelithiasis (5%), and pyloric obstruction (5%), while the latter included diaphragmatic and hiatus hernia (10% and 15%, respectively).The average operative time was 142 min. All patients had a regular (reviewer #1) postoperative course except for one who developed hydro-pneumothorax. At a median follow-up of 48 months, midterm outcomes were satisfactory, with an improvement (reviewer #1) in gastrointestinal symptoms. Three patients (reviewer #1) developed radiological recurrence without significant clinical symptoms. Patient's quality of life, including all parameters, significantly improved after the laparoscopic procedure compared to the preoperative values. Laparoscopic approach is safe and effective for managing adult diaphragmatic eventration (reviewer #1).
目前，关于腹腔镜在膈膨升（DE）治疗中作用的研究较少。本文主要描述了腹腔镜在以胃肠道症状为主的 DE 患者治疗中的作用。我们回顾性分析了 2010 年 1 月至 2018 年 12 月期间接受腹腔镜膈折叠术的 20 例患者的数据。评估了术后结果和生活质量。大多数 DE 为左侧（95%）。所有患者均成功完成了腹腔镜膈折叠术，同时纠正了所有相关的胃肠道和膈问题。前者包括胃扭转（60%）、反流性食管炎（25%）、胆石症（5%）和幽门梗阻（5%），后者包括膈疝和食管裂孔疝（10%和 15%）。平均手术时间为 142 分钟。除 1 例患者发生液气胸外，所有患者术后均恢复顺利。中位随访 48 个月，中期结果满意，胃肠道症状改善（reviewer #1）。3 例患者（reviewer #1）出现影像学复发，但无明显临床症状。与术前相比，患者生活质量（包括所有参数）在腹腔镜手术后显著改善。腹腔镜方法治疗成人膈膨升安全有效（reviewer #1）。
