Krähenbühl L, Schäfer M, Farhadi J, Renzulli P, Seiler C A, Büchler M W
Department of Visceral and Transplantation Surgery, Inselspital, University of Berne, Switzerland.
J Am Coll Surg. 1998 Sep;187(3):231-7. doi: 10.1016/s1072-7515(98)00156-2.
Once paraesophageal hernia has been diagnosed, it should be repaired immediately because of life-threatening complications such as bleeding, ischemia, and perforation when intrathoracic strangulation or volvulus occurs. We describe our surgical strategy for treating this rare type of hiatal hernia with regard to early and late postoperative complications.
This was a retrospective case series from a university hospital. Twelve patients (seven women and five men) with a mean age of 64 years (range, 50-76 years) and a completely intrathoracic stomach underwent laparoscopic paraesophageal hernia repair. Seven patients had a type 2 hernia, and five patients had a type 3 hernia. Additional organoaxial volvulus was present in three patients. All patients underwent reduction of the stomach and the greater omentum, excision of the hernia sac, closure of the hiatal defect, and a floppy Nissen fundoplication.
Because of severe adhesions, one patient needed an open stomach reduction (conversion rate, 8%). The mean operating time was 161 minutes (range, 110-200 minutes), blood loss was minimal, and the mean postoperative hospital stay was 6 days (range, 4-7 days). There were no intraoperative complications, but early postoperative complications occurred in three patients (25%; one with dysphagia, 1 reoperation due to organoaxial gastric rotation with gastroduodenal obstruction, and one with deep venous thrombosis). No deaths occurred. Followup in all patients is complete, with a mean followup time of 21 months (range, 3-40 months). The complication rate after long-term followup was 8%, and reflux esophagitis symptoms in one patient were completely relieved by medical therapy.
Laparoscopic paraesophageal hernia repair was feasible and safe with low morbidity and mortality rates in this elderly patient group. To achieve good long-term results, standard surgical treatment should include reduction of the stomach, complete excision of the hernia sac, closure of the hiatal defect, floppy Nissen fundoplication, and anterior gastropexy.
一旦确诊食管旁疝，应立即进行修复，因为当胸腔内发生绞窄或扭转时，会出现危及生命的并发症，如出血、缺血和穿孔。我们描述了针对这种罕见类型的裂孔疝的手术策略，涉及术后早期和晚期并发症。
这是一项来自大学医院的回顾性病例系列研究。12例患者（7例女性和5例男性），平均年龄64岁（范围50 - 76岁），胃完全位于胸腔内，接受了腹腔镜食管旁疝修补术。7例患者为2型疝，5例患者为3型疝。3例患者伴有器官轴型扭转。所有患者均接受了胃和大网膜复位、疝囊切除、裂孔缺损闭合以及宽松的nissen胃底折叠术。
由于严重粘连，1例患者需要开腹进行胃复位（转换率为8%）。平均手术时间为161分钟（范围110 - 200分钟），出血量极少，术后平均住院时间为6天（范围4 - 7天）。术中无并发症，但3例患者（25%）出现术后早期并发症（1例吞咽困难，1例因器官轴型胃扭转伴胃十二指肠梗阻再次手术，1例深静脉血栓形成）。无死亡病例。所有患者均完成随访，平均随访时间为21个月（范围3 - 40个月）。长期随访后的并发症发生率为8%，1例患者的反流性食管炎症状通过药物治疗完全缓解。
在这个老年患者群体中，腹腔镜食管旁疝修补术是可行且安全的，发病率和死亡率较低。为了获得良好的长期效果，标准的手术治疗应包括胃复位、疝囊完全切除、裂孔缺损闭合、宽松的nissen胃底折叠术和前胃固定术。
