Laparoscopic repair of paraesophageal hernia

被引:32
作者
Athanasakis, H
Tzortzinis, A
Tsiaoussis, J
Vassilakis, JS
Xynos, E [1 ]
机构
[1] Univ Crete, Univ Hosp Heraklion, Sch Med, Dept Gen Surg, Heraklion 71110, Crete, Greece
[2] Univ Crete, Univ Hosp Heraklion, Sch Med, Lab Gastrointestinal Motil, Heraklion 71110, Crete, Greece
关键词
D O I
10.1055/s-2001-15306
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Study Aim: Surgical repair of paraesophageal hernia is mandatory, due to the risk of severe complications, and it can be accomplished via the laparoscopic route. This study presents the results of laparoscopic repair of paraesophageal hernia combined with anterior hemifundoplication. Patients mid Methods: During a two-year period, ten consecutive patients with paraesophageal hernia (six men, four women; mean age 73, range 55-82) underwent laparoscopic treatment. Five patients presented with symptoms of gastroesophageal reflux, while another four reported lower chest pain. There was one patient in whom the paraesophageal hernia was manifested with upper gastrointestinal bleeding. Six patients had type III hiatal hernia. They all underwent esophagography, upper gastrointestinal endoscopy, stationary manometry, and 24-hour ambulatory pH-metry, preoperatively and within three months postoperatively. At laparoscopy, the hernia content was completely reduced, the sac excised, and the diaphragmatic crura approximated. The operation,vas completed with an anterior hemifundoplication. In three cases, a prosthetic mesh was applied to close the hiatal defect securely. Results: Operating times ranged from 75 min to 125 min (mean 90 min), There mere no postoperative deaths. One patient developed atelectasis, and another had empyema of the left pleura, treated with drainage and antibiotics. All patients but one were discharged on the second or third postoperative day. At the three-month follow-up examination, none of the patients had symptoms related to the paraesophageal hernia, gastroesophageal reflux, or fundoplication. Esophagography demonstrated restoration of normal anatomy at the gastroesophageal region, while esophageal motility was improved, and esophageal pH-metry showed no gastroesophageal reflux. Conclusion: Laparoscopic: repair of paraesophageal hernias is a safe, technically feasible, and well tolerated procedure, which offers rapid and total relief of symptoms.. The addition of an anterior hemifundoplication not only cures preexisting gastroesophageal reflux, but also prevents the development of postoperative gastroesophageal reflux.
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页码:590 / 594
页数:5
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