From the Albany Medical College, Albany, NY (McKay).
The Oregon Clinic: Center for Advanced Surgery, Portland, OR (Dunst, Davila-Bradley, Reavis).
J Am Coll Surg. 2024 Oct 1;239(4):333-338. doi: 10.1097/XCS.0000000000001099. Epub 2024 Sep 16.
Laparoscopic paraesophageal hernia (PEH) repair has a high hernia recurrence rate. The aim of this study was to assess the 5-year hernia recurrence rate after PEH repair using a combination of bioresorbable mesh and advanced surgical techniques to address tension as needed in a prospective group of patients.
In 2016, a prospective database was established for 50 patients undergoing primary, elective PEH repair with a new bioresorbable mesh (Phasix ST). Intraoperatively, tension was addressed with Collis gastroplasty and diaphragm relaxing incisions as needed. All 50 patients from the initial study were tracked and asked to return for objective follow-up. Recurrence was considered present for any hernia more than 2 cm in size.
Objective follow-up was conducted in 27 of the original 50 (54%) patients at a median of 5.25 years after their PEH repair. Before the 5-year follow-up, 5 patients had a known recurrent hernia. Objective evaluation at 5 years identified an additional 3 recurrences, for a total recurrence rate of 25% (8 of 32 patients). The hernia recurrence rate in patients with a Collis gastroplasty was significantly lower than in those without a Collis (7% vs 54%, p = 0.008). Two patients underwent reoperation for hernia recurrence. No patient had a mesh infection or mesh erosion.
The combination of Phasix ST Mesh and tension-reducing techniques during PEH repair led to a 25% hernia recurrence rate at 5 years. The addition of a Collis gastroplasty led to significantly fewer hernia recurrences and is indicative of the potential for esophageal shortening in many patients with a PEH. The long-term safety and efficacy of Phasix ST Mesh in combination with surgical technique for PEH repair is confirmed.
腹腔镜食管裂孔疝（PEH）修补术后疝复发率较高。本研究旨在评估 50 例采用生物可吸收网片和先进手术技术修复原发性、择期 PEH 患者的 5 年疝复发率，以应对术中张力，并根据需要进行胃切开 Collis 成形术和横膈膜松解切开术。对初始研究中的所有 50 例患者进行了跟踪，并要求他们返回进行客观随访。任何大于 2cm 的疝均被认为是复发。
2016 年，建立了一个前瞻性数据库，用于 50 例接受新型生物可吸收网片（Phasix ST）修复的原发性、择期 PEH 患者。术中，根据需要采用胃切开 Collis 成形术和横膈膜松解切开术来解决张力问题。对初始研究中的 50 例患者中的 27 例进行了客观随访，中位随访时间为 PEH 修复后 5.25 年。在 5 年随访之前，有 5 例患者已明确复发疝。5 年后的客观评估发现了另外 3 例复发，总复发率为 25%（32 例中有 8 例）。行胃切开 Collis 成形术的患者疝复发率明显低于未行胃切开 Collis 成形术的患者（7% vs 54%，p = 0.008）。2 例患者因疝复发行再次手术。无患者发生网片感染或网片侵蚀。
Phasix ST 网片与 PEH 修复术中的减压技术相结合，5 年后疝复发率为 25%。胃切开 Collis 成形术的应用显著降低了疝复发率，提示许多 PEH 患者存在食管缩短的可能。Phasix ST 网片与手术技术联合修复 PEH 的长期安全性和有效性得到证实。
