切除疝囊对于充分的腹腔镜食管旁疝修补术至关重要。
Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia.
作者信息
Edye M, Salky B, Posner A, Fierer A
机构信息
Division of Laparoscopic Surgery, The Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA.
出版信息
Surg Endosc. 1998 Oct;12(10):1259-63. doi: 10.1007/s004649900832.
BACKGROUND
We compared the incidence of early hernia recurrence in nonrandomized but consecutive patients undergoing laparoscopic repair of paraesophageal hernia (LRPH) without and with excision of the hernia sac.
METHODS
LRPH was completed in 55 of 58 patients. In the first 25 patients, the sac was not excised. Total sac excision was performed in the subsequent 30 patients. All patients had crural repair with or without fundoplication, or gastropexy.
RESULTS
Mean age of patients was 68 years (range, 34-95). There were three conversions; one patient died postoperatively. Mean operative time was 225 min in the first group and 190 min in the sac excision group. Median length of stay was 2 days (range, 1-15) for both groups.
CONCLUSIONS
A precise method of total sac excision simplified dissection. It also ensured complete reduction of the hernia and availability of adequate esophageal length. Operative time was not increased, and no subsequent early recurrences were observed (p < 0.05).
背景
我们比较了在接受腹腔镜食管旁疝修补术（LRPH）的非随机但连续患者中，未切除疝囊和切除疝囊的早期疝复发率。
方法
58例患者中有55例完成了LRPH。在前25例患者中，未切除疝囊。随后的30例患者进行了疝囊全切除。所有患者均进行了裂孔修补，可选择加或不加胃底折叠术或胃固定术。
结果
患者的平均年龄为68岁（范围34 - 95岁）。有3例中转手术；1例患者术后死亡。第一组的平均手术时间为225分钟，疝囊切除组为190分钟。两组的中位住院时间均为2天（范围1 - 15天）。
结论
精确的疝囊全切除方法简化了手术解剖。它还确保了疝的完全回纳和足够的食管长度。手术时间没有增加，且未观察到后续早期复发（p < 0.05）。
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