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1.
Scheidler MG Keenan RJ Maley RH Wiechmann RJ Fowler D Landreneau RJ 《The Annals of thoracic surgery》2002,73(2):416-419
BACKGROUND: True parahiatal diaphragmatic hernias are rare entities that are sparsely accounted for in the literature. The current report is intended to depict the clinical profile and assess the feasibility of laparoscopic repair of parahiatal hernias. METHODS: We conducted a retrospective review of all patients diagnosed and treated for parahiatal hernias. Clinical presentation and radiological assessment, as well as operative findings and repair, are discussed. RESULTS: Of the 917 laparoscopic hiatal hernia repairs, 2 (0.2%) patients were identified with a parahiatal hernia. The presenting symptoms and preoperative testing were similar to those with more common paraesophageal hernias. Laparoscopic repair was successful in repairing the diaphragmatic defect and alleviating symptoms up to 4 years postoperatively. CONCLUSIONS: Parahiatal hernias of the diaphragm appear to be rare primary diaphragmatic defects. The clinical presentation of parahiatal hernias is often indistinguishable from the more common paraesophageal pathology. Laparoscopic repair of this rare entity can be safely and successfully accomplished in conjunction with antireflux surgical interventions when indicated. 相似文献
2.
Background The use of mesh for laparoscopic repair of large hiatal hernias may reduce recurrence rates in comparison to primary suture
repair. However, there is a potential risk of mesh-related oesophageal complications due to prosthesis erosion. The aim of
this study was to critically evaluate a novel mesh (DualMesh) repair of hiatal hernias with particular reference to intraluminal
erosion.
Method Medical records of 19 patients who underwent laparoscopic hiatal hernia repair with DualMesh reinforcement of the crural closure
were reviewed from a prospectively collected database. Quality of life and symptom analysis was performed using quality of
life in reflux and dyspepsia (QOLRAD) questionnaires pre- and postoperatively after 6 weeks, 6 months, 1 year and 2 years.
Barium studies were performed on patients pre-operatively and two years postoperatively to assess hernia recurrence. After
2 years, oesophagogastric endoscopy was performed to assess signs of erosion.
Results Mean patient age was 70.5 years (range 49–85 years). Two years after hiatal hernia repair, there was significant improvement
in quality-of-life scores (QOLRAD: p < 0.001). Follow-up barium studies performed at 31.3 months (range 29–40 months) after surgery showed moderate recurrent
hernias (>4 cm) in 1/14 patients (7%). Endoscopies performed at 34.4 months (range 28–41 months) after surgery did not show
any signs of prosthetic erosion.
Conclusion Laparoscopic reinforcement of primary hiatal closure with DualMesh leads to a durable repair in patients with large hiatal
hernias. Long-term endoscopic follow-up did not show any signs of mesh erosion after prosthetic reinforcement of the crural
repair. 相似文献
3.
C. Palanivelu M. Rangarajan P. A. Jategaonkar N. V. Anand K. Senthilkumar 《Hernia》2008,12(6):649-653
Background Paraduodenal hernias are the most common form of internal hernias. There are few reports in the literature, with the total
number of reported cases being less than 500. We report four patients with paraduodenal hernias causing intestinal obstruction.
Materials and methods All of the four patients with paraduodenal hernias presented with features of intestinal obstruction. A clinical diagnosis
was not made in any of the cases, and computed tomography (CT) scanning was performed to confirm this. They were all successfully
managed by a laparoscopic repair.
Results The operating time was 55–72 mins. Postoperatively, three patients recovered uneventfully, while one patient had ileus for
3 days and, thereafter, recovered spontaneously. Hospital stay was in the range 2–6 days. There were no conversions. One patient
had recurrent paraduodenal hernia, for which a laparoscopic mesh repair was successfully performed.
Discussion The mechanism of the herniation is thought to be a defective rotation of the superior mesenteric vein during embryonic development.
Paraduodenal hernias are not high on the list of differentials for bowel obstruction. Some form of surgery is mandatory for
all cases. The inferior mesenteric vein has to be sacrificed in some cases to facilitate reduction of the hernia contents.
A mesh repair is reserved for large defects and recurrent hernias. Laparoscopic repair has been infrequently reported in the
literature. Based on our experience, the laparoscopic approach seems to be effective in the repair of paraduodenal hernias.
It carries all of the benefits of minimal access surgery, while providing a sound repair. 相似文献
4.
C. Palanivelu M. Rangarajan R. Parthasarathi M. V. Madankumar K. Senthilkumar 《Hernia》2008,12(3):251-256
BACKGROUND: Suprapubic hernias are those defects located 4 cm from the pubic symphysis. Our aim is to highlight the laparoscopic repair of suprapubic incisional hernias. PATIENTS AND METHODS: We retrospectively reviewed 17 patients with suprapubic incisional hernias from 1999 to 2007. A modified technique of laparoscopic intraperitoneal composite mesh onlay was performed for these patients. RESULTS: There were 12 females and 5 males with a mean age of 55.9 years and a mean BMI of 30 kg/m(2). The mean hernia size was 87.5 cm(2), with an average mesh size of 234 cm(2). Mean follow-up was 9 months. Complications were seen in five patients, with an overall recurrence rate of 5.8%. DISCUSSION: Suprapubic hernias are difficult to manage because of the complexity of dissection and their anatomic proximity to bony, vascular and nerve structures. The lower end of the mesh should be fixed to the Cooper's ligament and the pubic bone. Laparoscopic repair of these uncommon hernias is safe, effective and provides all the benefits of minimally invasive surgery. 相似文献
5.
The repair of hernias through iliac crest defects is challenging secondary to the inherent weakness of the abdominal musculature
and the rigidity of the pelvis. The defect is surrounded by inadequate tissue to properly buttress the repair. Full-thickness
tricortical bone harvested from the iliac may result in an incisional hernia through the bony defect. Options for repair include
using the aponeurosis of the gluteus muscle, prosthetic material, or straightening the iliac crest. We report two patients
who had their defects repaired laparoscopically using polytetrafluoroethylene (PTFE) mesh. Two patients with hernias following
full-thickness iliac crest bone harvest presented secondary to increasing pain and size of their hernias. Both defects were
repaired laparoscopically using spiral tacks laterally, medially, and superiorly, and with an intracorporeal stitch inferiorly
at the iliac crest to secure the mesh. The two defects averaged 24.5 cm2 in size and were repaired with PTFE mesh. For adequate visualization, the cecum was mobilized and the mesh repair overlapped
the defects by a 4-cm margin. Both patients were discharged after 2.5 days. There were no infectious or neurologic complications,
and neither patient has recurred. The laparoscopic approach to the repair of hernias resulting from tricortical iliac crest
bone harvest is safe and may be preferable to open repair. Advantages include durable repair, better interoperative visualization,
and reduced post-operative pain, morbidity, and hospital stay. 相似文献
6.
Redo laparoscopic fundoplication and laparoscopic repair of large (>5cm) paraesophageal hernias have a high rate of recurrence after primary suture repair of the hiatal defect. As such, the use of mesh prosthesis as an interposition graft or onlay reinforcement is becoming more popular for the repair of larger, more complicated crural defects. We report three cases in which human acellular dermal matrix was used as an onlay reinforcement of the hiatus after primary suture closure. Two patients had large paraesophageal hernias (one type III and one type IV). The third patient became symptomatic after her second laparoscopic antireflux procedure and was found to have recurrent herniation of the fundus into the mediastinum. All three patients underwent successful laparoscopic repair. There were no intraoperative or postoperative complications. All three patients remain symptom free with follow-up ranging from 8 months to 10 months. Acellular dermal matrix appears to be a promising prosthetic for onlay reinforcement of the hiatus during redo laparoscopic fundoplication and repair of large paraesophageal hernias. 相似文献
7.
Background Acute paraesophageal hernia is a surgical emergency presenting with sudden chest or abdominal pain, dysphagia, vomiting, retching
or significant anemia. Severe cases can present with respiratory failure or systemic sepsis. This can be due to gastric volvulus,
incarceration, strangulation, severe bleeding or perforation. Traditionally this has been treated with an open surgery. The
purpose of this study is to develop a management algorithm and evaluate the role of a laparoscopic approach for these cases.
Methods A retrospective chart review was performed for patients operated on for paraesophageal hernia at the Peter Lougheed Centre
from 2004 to 2007 inclusive. Patients admitted with acute symptoms requiring emergency surgery were selected for the study.
Results Twenty patients were identified. Seventeen patients underwent successful laparoscopic repair including reduction of the hernia
content, excision of the sac, crural closure, and fundoplication (Dor or Nissen). Fifteen of these were done semi-urgently.
Three patients had open repair. One patient was converted to open due to ischemic gastric perforation and peritoneal contamination.
Another patient had right thoracotomy followed by laparotomy for mediastinal contamination. A third patient with a body mass
index (BMI) of 49 kg/m2 was converted to open for a type VI paraesophageal hernia. Mean operating time for the laparoscopic group was 190.5 min,
blood loss was minimal, and mean postoperative hospital stay was 8.2 days. There were no significant perioperative complications.
All patients were tolerating regular diet on short-term follow-up.
Conclusion Laparoscopic repair of acute paraesophageal hernia is safe and feasible with low morbidity and mortality. It affords all the
benefits of minimally invasive surgery in a group of patients that are often elderly and suffer from multiple medical problems.
Based on our experience, we advocate the laparoscopic technique to repair acute paraesophageal hernias in patients with no
obvious perforation. A management algorithm is also suggested. 相似文献
8.
Background Lumbar hernias that occur after surgery are called lumbar incisional hernias. Recently, laparoscopic repair of these hernias
has been reported with excellent outcomes. This is a retrospective study of our series of patients with lumbar incisional
hernias.
Patients and methods We managed 11 patients with lumbar incisional hernias from 1996–2006. All the patients had undergone either nephrectomy or
pyeloplasty in the past. Laparoscopic suturing of the defect and reinforcement with mesh were successfully performed for all
the patients.
Results There were more males than females, the age range was 42–65 years, and mean operating time was 120 min; discharge was at 1–2 postoperative days.
There was no recurrence or mortality. Three cases had seroma, out of which two required aspiration after 60 days.
Discussion Laparoscopic repair provides all the benefits of minimally invasive surgery, and the principles involved in repair of ventral
hernias are applied in lumbar incisional hernias as well. Our technique involved suturing of the defect before placing a mesh
over the defect. We theorize that approximating the ends of the muscles restores normal anatomy and results in functional
improvement. For the larger hernias, we used two meshes to cover the defect—polypropylene and Parietex™, sizes being 15 × 15 cm.
Conclusion Laparoscopic repair with prosthetic reinforcement is feasible and effective in the treatment of lumbar incisional hernias.
Also, suturing of the defect may provide additional benefits. 相似文献
9.
Steyaert H Al Mohaidly M Lembo MA Carfagna L Tursini S Valla JS 《Surgical endoscopy》2003,17(4):543-546
Background: Laparoscopic fundoplication is a commonly performed procedure in children. This report describes the incidence
of long-term recurrence and complications after laparoscopic Nissen or Toupet fundoplication in neurologically impaired and
normal children. Methods: Fifty-three children operated on before 1999 were reviewed. All children were evaluated clinically
and with a barium meal study thereafter. Symptomatic children and those with abnormal barium meal underwent 24 h pH monitoring.
Results: A total of 45 patients were included in the study. The mean follow-up was 4.5 years. All, except one asymptomatic
child that declined, had a barium meal. Four were abnormal (2 parahiatal hernias and 2 slight episodes of reflux). Four patients
had symptoms related to the operation and 2 to clinical recurrence. Only 1 asymptomatic child with slight reflux at barium
meal revealed abnormal 24 h pH monitoring. Finally, 6.6% patients were found to have late recurrence (2 clinical and 1 pHmetry).
There was an obvious increase in children's weight, especially in neurologically impaired patients. Conclusion: Laparoscopic
antireflux surgery is of value in children with gastroesophageal reflux disease. The long-term results are comparable with
open surgery, and there was no difference in term of wrap failure between neurologically impaired and normal children. 相似文献
10.
Background Recurrences continue to be seen after repair of inguinal hernias. The repair of these recurrent hernias is a more complex
and demanding procedure, with a high re-recurrence rate. Definite advantage has been demonstrated with endoscopic repair of
these hernias.
Methods The results for this prospective study from January 2003 to December 2006 were evaluated after laparoscopic repair of 65 recurrent
hernias in 61 patients. The patients were followed up for 1 year. Longer follow-up evaluation was performed for the patients
who underwent surgery in the initial 3 years.
Results In this study, 37 recurrent hernias were managed using the transabdominal preperitoneal technique (TAPP) technique and 28
using the totally extraperitoneal (TEP) technique. There was no conversion and no cases of postoperative wound infection.
Of the 12 metachronous hernias repaired simultaneously, 3 were occult. Seroma developed in five patients. At a follow-up assessment
after 1 year, one patient had groin pain, and there was one re-recurrence. A longer follow-up period with a mean of 35.11 months
failed to show any new re-recurrence.
Conclusions Laparoscopic repair of recurrent inguinal hernia is safe and effective. The morbidity and recurrence rates for the procedure
are as low as for laparoscopic repair of primary hernias. Laparoscopic repair should be the gold standard for these hernias. 相似文献
11.
Background: Laparoscopic treatment of large mixed hiatal hernias was attempted in eight patients.
Methods: One patient (12.5%) was converted to open surgery due to difficulty in repositioning the LES into the abdomen resulting from a shortened esophagus. One left pleural tear occurred intraoperatively and was repaired without further consequence. Median duration of the operation was 150 min (range 120–300 min).
Results: No postoperative complications were recorded. All patients are asymptomatic after a median follow-up of 14 months (range 7–15 months). Correct repositioning of the stomach was confirmed by radiological evaluation 1 month after surgery. Early functional results are good. (One asymptomatic gastroesophageal reflux was detected and medical treatment was undertaken).
Conclusions: Laparoscopic crural repair and fundoplication are feasible even in paraesophageal and large mixed hiatal hernias. Advantages of the minimally invasive approach are clear in terms of morbidity, patient comfort, and duration of hospital stay. Nevertheless, long-term assessment is required to confirm the effectiveness of the laparoscopic approach in patients with large mixed hiatal hernias. 相似文献
12.
Background The use of mesh for laparoscopic repair of large hiatal hernias may reduce recurrence rates in comparison with primary suture
repair. However, there is a potential risk of mesh-related oesophageal complications due to prosthesis erosion. The aim of
this study was to evaluate a lightweight polypropylene mesh (TiMesh) repair of hiatal hernias with particular reference to
intraluminal erosion.
Methods Data were collected prospectively on 18 consecutive patients undergoing elective laparoscopic repair of a large hiatal hernia
with the use of TiMesh between November 2004 and December 2005. Quality of life and symptom analysis was performed using QOLRAD
questionnaires preoperatively and postoperatively after 6 weeks, 6 months, 1 year and 2 years. Barium studies were performed
preoperatively and 2 years postoperatively to assess hernia recurrence. After 2 years, oesophagogastric endoscopy was performed
to assess signs of mesh-related complications.
Results All operations were completed laparoscopically. There was no 30-day mortality and median hospital stay was 2.8 days (range
2–13 days). Complications occurred in two patients (11%), both of whom were treated without residual disability. Two years
after hiatal hernia repair, there was significant improvement in quality-of-life scores (QOLRAD 5.79, p < 0.001). There was no difference between pre- and postoperative dysphagia scores. No signs of stricture formation or prosthetic
erosion were identified during endoscopic follow-up. One patient had a small (2 cm) sliding hiatal hernia demonstrated by
barium studies, which was asymptomatic.
Conclusions Laparoscopic reinforcement of primary hiatal closure with TiMesh leads to a durable repair in patients with large hiatal hernias.
Endoscopic follow-up did not show any signs of mesh-related complications after prosthetic reinforcement of the crural repair.
Our preliminary results suggest that it is safe to proceed with this lightweight polypropylene mesh for reinforcement of the
hiatal repair. 相似文献
13.
Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study 总被引:4,自引:0,他引:4
Background Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair
to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of
consensus, needs prospective randomized controlled trials.
Methods Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive
either open retrorectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals
thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group).
Results Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (∼50%) in both groups. There
was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm2 in the open (group 1) and 65.66 cm2 in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm2 and 203.83 cm2. The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications
occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55).
Conclusions Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood
loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome. 相似文献
14.
Granderath FA Kamolz T Schweiger UM Pointner R 《Archives of surgery (Chicago, Ill. : 1960)》2006,141(7):625-632
HYPOTHESIS: Prosthetic crural closure does not adversely influence esophageal body motility. In most patients, postoperative increased dysphagia resolves spontaneously during the first months after surgery. DESIGN: Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatal closure and those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure. SETTING: University-affiliated community hospital. PATIENTS: Forty consecutive patients who underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease. INTERVENTIONS: A 360 degrees Nissen fundoplication with simple sutured crura (n = 20; nonmesh group) vs the same procedure with posterior 1 x 3-cm polypropylene onlay mesh prosthesis (n = 20; mesh group). MAIN OUTCOME MEASURES: Recurrences; postoperative dysphagia rate; localization, length, and pressure of the lower esophageal sphincter (LES); results of 24-hour pH monitoring; esophageal body motility; peristalsis; and esophageal amplitude of contraction and interrupted waves. RESULTS: Preoperatively, both groups had pathological LES pressure and DeMeester scores. These values improved significantly (P < .01) after surgery and remained stable at 1 year after surgery. Patients in the nonmesh group had a significantly lower LES pressure 1 year after surgery compared with those in the mesh group. There were no significant differences in postoperative mean LES length (4.1 vs 3.8 cm), LES relaxation (93.4% vs 92.4%), and intra-abdominal LES length (2.1 vs 2.1 cm). Patients in the mesh group had fewer simultaneous waves and interrupted waves 1 year after surgery, but the difference between groups was not significant. There were no significant differences in interrupted waves and amplitude of contraction between groups 1 year after surgery. CONCLUSION: Laparoscopic Nissen fundoplication with prosthetic crural closure does not impair postoperative esophageal body motility compared with laparoscopic Nissen fundoplication with simple suture hiatal closure, although it is associated with a higher rate of short-term dysphagia. 相似文献
15.
A laparoscopic approach to incisional hernia repair has been shown to be safe and effective in selected patients. We report our early outcomes following laparoscopic ventral/incisional hernia repair (LVHR) in an unselected series of patients encountered in general surgery practice. All patients referred with incisional hernia were offered a laparoscopic repair using prosthetic mesh. Patients were not excluded from laparoscopic approach on the basis of age, previous surgery, defect size, intraperitoneal mesh, body mass index (BMI), comorbidities, or abdominal wall stomas. We followed 28 consecutive patients who underwent LVHR (17 primary, 11 recurrent hernias). Laparoscopic repair was completed in 27 patients with a mean operative time of 141.6 +/- 11.9 minutes. There were no intraoperative complications. The mean size of the abdominal wall defects was 153.4 +/- 27.5 cm and the mean mesh size was 349.2 +/- 59.1 cm. The mean hospital stay was 3.7 +/- 0.3 days. Nine patients developed large wound seromas; all spontaneously resolved. Our experience suggests that LVHR is feasible as a primary approach to most incisional hernias encountered in general surgery practice. 相似文献
16.
Background Paraoesophageal hernias are an uncommon but important diaphragmatic defect due to a high prevalence of associated complications.
The advent of laparoscopic surgery has popularised the surgical management of this condition, although the optimal technique
has yet to be defined. The aim of this cohort study was to assess the necessity of an anti-reflux procedure in addition to
the crural repair.
Methods Details of all patients undergoing laparoscopic paraoesophageal hernia repair were collected prospectively paying particular
attention to the details of the operative procedure and outcome, including the development of early complications. All patients
were followed for six months and symptoms related to hernia recurrence or technical failure including dysphagia and reflux
were noted.
Results Twenty-three consecutive patients underwent laparoscopic paraoesophageal hernia repair. The first 11 patients (Group 1) routinely
underwent an additional anti-reflux procedure, whereas the later cohort (Group 2) did not (chi-squared P < 0.05). At six months, nine of eleven patients in Group 1 reported dysphagia, in two cases requiring dilatation, but this
complication was not seen in those in Group 2. Two patients reported reflux at six-month follow-up; this was controlled in
both cases by a low dose of a proton pump inhibitor.
Conclusion Laparoscopic repair of paraoesophageal hernias is an effective treatment with excellent short-term results and no recurrences.
Our experience would suggest that an anti-reflux procedure is not always indicated and may indeed be detrimental to symptomatic
outcome. 相似文献
17.
Chinnusamy Palanivelu Muthukumaran Rangarajan Subbiah Rajapandian Vennapusa Amar Ramakrishnan Parthasarathi 《Surgical endoscopy》2009,23(5):978-985
Background Diaphragmatic hernias may be congenital or acquired (traumatic). Some patients present in adulthood with a congenital hernia
undetected during childhood or due to trauma, known as the adult-onset type. The authors present their series of adult-onset
type diaphragmatic hernias managed successfully by laparoscopy.
Methods This study retrospectively investigated 21 adult patients between 1995 and 2007 who underwent laparoscopic repair at the authors’
institution, 15 of whom were symptomatic. Laparoscopic repair was performed with mesh for 18 patients and without mesh for
three patients who had Morgagni hernia.
Results In this series, Bochdalek hernia (n = 12), Morgagni hernia (n = 3), eventration (n = 3), and chronic traumatic hernia (n = 3) were treated. Intercostal drainage was required for 14 patients, whereas in three cases the hypoplastic lung never reinflated
even after surgery. The time of discharge was in the range of postoperative days 4 to 9. The complication rate was 19%, and
mortality rate was 4.5%. One case of recurrence was noted after 10 months.
Conclusion The controversies involved are the surgical approach, management of the hernial sac, whether or not to suture the defect,
and choice of prosthesis. Although laparoscopic and thoracoscopic approaches are comparable, the laparoscopic approach seems
to have certain distinct advantages. The authors prefer not to excise the hernial sac and favor suturing the defects before
mesh reinforcement. Regarding the type of mesh used, composite, expanded polytetrafluoroethylene (ePTFE), or polypropylene
are the available options. Laparoscopic repair is feasible, effective, and reliable. It could become the gold standard in
the near future. 相似文献
18.
Laparoscopic management of giant paraesophageal herniation 总被引:6,自引:0,他引:6
Wiechmann RJ Ferguson MK Naunheim KS McKesey P Hazelrigg SJ Santucci TS Macherey RS Landreneau RJ 《The Annals of thoracic surgery》2001,71(4):1080-6; discussion 1086-7
BACKGROUND: Many surgeons have found laparoscopic fundoplication effective management of medically recalcitrant gastroesophageal reflux disease (GERD) associated with sliding type I hiatal hernias. The anatomic distortion and technical difficulty inherent with repair has limited the use of laparoscopy for repair of "giant" paraesophageal hernias (gPH). METHODS: Since July 1993, we have accomplished laparoscopic repair of paraesophageal hiatal hernias in 54 of 60 (90%) patients. Five patients had classic type II hernias with total intrathoracic stomachs, and 53 patients had large sliding/paraesophageal type III herniation. Two patients had true parahiatal hernias. None had gastric incarceration. Median age was 53 years and 28 of 60 (47%) were women. Chest pain and dysphagia were primary complaints from 39 of 60 (65%). Heartburn with or without regurgitation was present in 52 of 60 (85%). Preoperative manometry and prolonged pH testing were obtained on 43 of 60 (72%) and 44 of 60 (73%) patients, respectively. Principles of repair included reduction of the hernia, excision of the sac, crural approximation, and fundoplication over a 54F bougie (Nissen, 41; Dor, 1; Toupet, 18) to "pexy" the stomach within the abdomen and to control postoperative reflux. RESULTS: Mean operative time was 202+/-81 minutes. Conversion to "open" repair was required in 6 patients (iatrogenic esophageal injury in 2 patients and difficult hernia sac dissection in 4 patients). One postoperative mortality occurred as a result of sepsis and multiorgan failure after an intraoperative esophageal perforation. Follow-up barium swallow performed in 44 of 60 patients demonstrated recurrent hiatal hernias in 3 patients. Preoperative symptoms have been relieved in all but 3 patients. Reoperation for recurrent paraesophageal herniation has been required in these latter 3 patients. CONCLUSIONS: Although technically challenging, laparoscopic repair of paraesophageal hiatal hernias is a viable alternative to "open" surgical approaches. Control of the herniation and the patient's symptoms are equivalent and hospitalization and return to full activity are shorter. 相似文献
19.
Denise E. Hilling Linetta B. Koppert Richard Keijzer Laurents P. S. Stassen I. Hok Oei 《Surgical endoscopy》2009,23(8):1740-1744
Background Laparoscopic repair of umbilical hernias is usually based on the open underlay procedure in which the mesh is placed intra-abdominally.
To prevent complications such as adhesions, bowel obstruction and fistula formation we developed a new laparoscopic approach,
placing the mesh in the preperitoneal space.
Methods Our laparoscopic approach concerns a standardised procedure with introduction of three intra-abdominally placed trocars. The
ventral abdominal wall is incised in a lengthwise manner approximately 5 cm from the umbilical defect, followed by development
of the preperitoneal space, reposition of the umbilical peritoneal sac and placement and fixation of a ProleneTM mesh. The mesh is secured using transfascial ProleneTM sutures; the peritoneal defect is closed with a running VicrylTM suture. Data on 17 patients with primary umbilical hernias laparoscopically operated on between April 2002 and March 2006
are presented.
Results The 11 men and 6 women had a mean age of 57.8 years (range 37–91 years) and a mean body mass index (BMI) of 30.6 kg/m2 (range 23.7–37.9 kg/m2). Mean hernia size was 1.95 cm (range 1–3 cm), average mesh size was 110 cm2 (range 100–150 cm2). Mean operating time was 85.6 min (range 60–120 min). Mean hospital stay was 2.2 days (range 1–3 days). No major complications
were seen. No recurrences were observed during a mean follow-up of 36.2 months (range 13–62 months).
Conclusions The preperitoneal laparoscopic technique for umbilical hernia repair combines the advantages of a laparoscopic, minimally
invasive, approach, avoiding the potential complications related to intra-abdominal mesh position. 相似文献
20.