Agwunobi A O, Bancewicz J, Attwood S E
Department of Surgery, Royal Albert Edward Infirmary, Wigan, UK.
Br J Surg. 1998 May;85(5):604-6. doi: 10.1046/j.1365-2168.1998.00639.x.
Paraoesophageal hiatal hernia is relatively rare compared with sliding hernia but it is associated with serious complications. Its clinical management presents a major challenge since many patients are elderly and unfit for a formal repair. This paper describes a laparoscopic method aimed at reducing the complications of open repair.
Thirteen patients treated for symptomatic paraoesophageal hernia were included in the study. Eleven patients successfully underwent a simple laparoscopic modification of the Boerema anterior gastropexy. Two patients required an open anterior gastropexy through a minilaparotomy because of incomplete reduction of the hernia. A five-puncture technique was used. The stomach and any other contents of the sac were reduced into the abdomen and the stomach was firmly fixed to the fascia of the anterior abdominal wall with GORE-TEX sutures tied extracorporeally.
There was one postoperative death due to spontaneous intrathoracic perforation of the posterior aspect of the stomach in an elderly woman with severe cardiac disease. There was no postoperative morbidity. Eight of the ten patients who went home following laparoscopic gastropexy have remained asymptomatic on follow-up. In three patients, two in the laparoscopic group and one in the open group, symptoms recurred.
While anterior gastropexy has a significant incidence of recurrent herniation, the clinical results of this simple procedure in a high-risk population support its use as the initial surgical option.
与滑动性疝相比，食管旁裂孔疝相对少见，但它会引发严重并发症。其临床治疗颇具挑战，因为许多患者年事已高且不适于进行正规修补手术。本文介绍一种旨在减少开放修补并发症的腹腔镜手术方法。
本研究纳入13例因有症状的食管旁疝接受治疗的患者。11例患者成功接受了简单的腹腔镜改良布尔马前胃固定术。2例患者因疝未能完全回纳，通过小切口剖腹术进行了开放前胃固定术。采用五点穿刺技术。将胃及疝囊内的任何其他内容物回纳至腹腔，并用戈尔泰克斯缝线在体外打结，将胃牢固固定于前腹壁筋膜。
1例患有严重心脏病的老年女性患者术后因胃后壁自发性胸腔内穿孔死亡。无术后发病情况。接受腹腔镜胃固定术后回家的10例患者中，8例在随访中无症状。3例患者症状复发，其中2例在腹腔镜组，1例在开放手术组。
虽然前胃固定术有较高的疝复发率，但该简单手术在高危人群中的临床效果支持将其作为初始手术选择。
