Oddsdottir M, Franco A L, Laycock W S, Waring J P, Hunter J G
Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
Surg Endosc. 1995 Feb;9(2):164-8. doi: 10.1007/BF00191959.
Large paraesophageal hernias are generally repaired by reduction of the stomach into the abdomen, sac excision, crural closure, and gastropexy or fundoplication. After gaining experience performing laparoscopic repair of sliding hiatal hernias and Nissen fundoplication we combined laparoscopic access with traditional surgical technique in treating patients with complex paraesophageal hernias. Ten adults, six males and four females, with type III paraesophageal hernias underwent laparoscopic repair between February 1993 and April 1994. The average age of the patients was 60.4 years (range 38-81). Using five ports (three 10 mm and two 5 mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with pledgeted horizontal mattress sutures. In addition, nine patients had a Nissen fundoplication performed and one patient had a diaphragmatic gastropexy. The procedure was completed laparoscopically in all ten cases and the median operating time was 282 min (range 165-430). Two complications occurred, an intraoperative gastric laceration, and a postoperative mediastinal seroma. All patients were discharged on the 2nd or 3rd postoperative day. Eight of nine patients were asymptomatic at last follow-up (mean 8.9 months postop). One patient has mild dysphagia and heartburn from partial migration of the fundoplication into the chest. One patient died 3 months postoperatively of unrelated causes. Paraesophageal hernia can be reduced and repaired safely with laparoscopic access using standard surgical techniques.
大型食管旁疝通常通过将胃还纳至腹腔、切除疝囊、缝合膈肌脚以及进行胃固定术或胃底折叠术来修复。在积累了腹腔镜下修复滑动性食管裂孔疝和nissen胃底折叠术的经验后，我们将腹腔镜入路与传统手术技术相结合，用于治疗复杂的食管旁疝患者。1993年2月至1994年4月期间，10例成年患者（6例男性，4例女性）接受了III型食管旁疝的腹腔镜修复术。患者的平均年龄为60.4岁（范围38 - 81岁）。使用5个端口（3个10毫米和2个5毫米），将胃还纳至腹腔，切除疝囊，并用带垫片的水平褥式缝线封闭缺损。此外，9例患者进行了nissen胃底折叠术，1例患者进行了膈肌胃固定术。所有10例手术均通过腹腔镜完成，中位手术时间为282分钟（范围165 - 430分钟）。发生了2例并发症，1例术中胃撕裂，1例术后纵隔血清肿。所有患者均在术后第2天或第3天出院。9例患者中有8例在最后一次随访时（平均术后8.9个月）无症状。1例患者因胃底折叠术部分移入胸腔而出现轻度吞咽困难和烧心。1例患者术后3个月因无关原因死亡。使用标准手术技术通过腹腔镜入路可以安全地还纳并修复食管旁疝。
