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首页> 外文期刊>World Journal of Surgery: Official Journal of the Societe Internationale de Chirurgie, Collegium Internationale Chirurgiae Digestivae, and of the International Association of Endocrine Surgeons >Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results.
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Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results.

机译：腹腔镜翻修胃底折叠术与圆形裂孔裂孔网假体：长期结果。

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BACKGROUND: Failure of hiatal closure has proven to be the most frequent complication leading to revisional surgery after primary failed open or laparoscopic antireflux surgery. To prevent hiatal hernia recurrence some authors recommend the use of prosthetic meshes for reinforcement of the hiatal crura. The aim of the present prospective study was to evaluate the safety and effectiveness of a circular hiatal onlay mesh prosthesis applied during laparoscopic refundoplication after primary failed antireflux surgery with intrathoracic wrap migration. The follow-up period was 5 years. METHODS: A total of 33 patients underwent laparoscopic refundoplication for recurrent symptoms of gastroesophageal reflux disease after primary failed laparoscopic or open antireflux surgery. The underlying morphological complication for symptom recurrence in all patients was hiatal hernia recurrence with intrathoracic migration of the fundoplication. During revisional surgery, after breakdown of the former fundoplication, the esophageal hiatus was thoroughly revised and a circular polypropylene mesh was used to buttress the primarily simple sutured hiatal crura. Additionally, in all patients a refundoplication was performed. Recurrences, complications, functional data, esophagogastroduodenoscopy, and cinematographic X-ray results, as well as quality of life data, were evaluated for the 60-month follow-up period. RESULTS: All reoperations were successfully completed laparoscopically. Twenty-one patients underwent laparoscopic 360 degrees "floppy" Nissen refundoplication, and 12 patients underwent laparoscopic 270 degrees Toupet refundoplication. Hiatal closure was performed by placing a circular polypropylene sheet that had a 3-4 cm keyhole for the esophageal body. Of 24 patients who underwent redo-surgery before May 2000, no patient developed a recurrent hiatal hernia during the first 12 postoperative months. All 33 patients were re-evaluated and underwent complete diagnostic work-up over a follow-up period of 60 months postoperatively. During the long-term follow-up, a new recurrent hiatal hernia with intrathoracic wrap migration developed in 2 patients (6%). In both cases, slippage occurred anteriorly to the esophagus. Both patients were scheduled for repeat refundoplication. In all other patients no recurrence occurred for the complete follow-up period, and no mesh-related complications developed. CONCLUSIONS: Laparoscopic refundoplication for primary failed hiatal closure with the use of a circular mesh prosthesis is a safe and effective procedure to prevent hiatal hernia recurrence for short- and mid-term follow-up. However, for long-term follow-up, even with the placement of prosthetic mesh, re-recurrence occurs in some patients, leading to repeated surgery.
机译：背景：食管裂孔闭合失败已被证明是最常见的并发症，导致原发性开腹或腹腔镜抗反流手术失败。为了防止食管裂孔疝复发，一些作者建议使用假体网片来增强食管裂孔。本项前瞻性研究的目的是评估在原发性抗回流手术失败并伴有胸膜内包裹移行后，腹腔镜下复张术中应用的圆形裂孔网状假体的安全性和有效性。随访期为5年。方法：33例因原发性腹腔镜手术或开腹反流手术失败的胃食管反流病复发症状而进行了腹腔镜胃返流术。所有患者症状复发的潜在形态学并发症是食管裂孔术引起的食管裂孔疝复发。在翻修手术期间，在前胃底折叠术破裂后，食管裂孔被彻底翻修，并使用圆形聚丙烯网支撑最初简单缝合的裂孔at骨。另外，在所有患者中都进行了重复复制。在60个月的随访期内，评估了复发，并发症，功能数据，食管胃十二指肠镜检查和X线电影摄影结果以及生活质量数据。结果：所有再次手术均在腹腔镜下成功完成。 21例患者接受了360度“松散” Nissen重复腹腔镜手术，12例患者接受了270度的Toupet重复腹腔镜手术。通过放置一块圆形的聚丙烯薄片进行食管闭合，该薄片具有一个3-4厘米的食道小孔。在2000年5月之前进行过重做手术的24例患者中，没有患者在术后的前12个月内复发性食管裂孔疝。在术后60个月的随访期内，对所有33例患者进行了重新评估并进行了完整的诊断检查。在长期随访中，有2例患者（6％）出现了新的复发性食管裂孔疝并伴有胸膜内包裹迁移。在这两种情况下，滑倒都发生在食道的前面。两名患者均计划重复进行重复造血术。在所有其他患者中，整个随访期间均未复发，也未发生网状并发症。结论：腹腔镜下复膜原发性食管裂孔术失败并使用圆形网状假体是一种安全有效的方法，可防止食管裂孔疝在短期和中期随访中复发。但是，对于长期随访，即使放置了假体网片，某些患者也会再次复发，导致重复手术。

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