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首页> 外文期刊>Surgical Endoscopy >Minimal versus obligatory dissection of the diaphragmatic hiatus during magnetic sphincter augmentation surgery
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Minimal versus obligatory dissection of the diaphragmatic hiatus during magnetic sphincter augmentation surgery

机译：磁性括约肌增强手术期间膈肌的最小与强制解剖

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摘要

BackgroundThe magnetic sphincter augmentation (MSA) device was initially implanted with minimal hiatal dissection (MHD) at the diaphragmatic hiatus. Due to concern of possible MSA device dysfunction if herniated into an occult or small hiatal hernia, and increased understanding to the role of defective crura in reflux disease, the operative procedure was changed to planned obligatory dissection (OD) of the hiatus at the time of all implantations.MethodsBetween December 2012 and September 2016, 182 patients underwent MSA implant at a single medical center and have complete records available for review through September 2017. The MHD dissection period extended from December 2012 to September 2015, from September 2015 to 2016 all patients underwent OD.ResultsMHD occurred 53% (96/182) versus OD in 47% (86/182), mean follow-up time in days for MHD and OD was 554 (SD 427) versus 374 (298)days. Intraoperative measurement of hernia size for the MHD versus OD was 0.77 (1.1) versus 3.95 (2.4)cm, p<0.001. At first visit follow-up, there was no difference in any dysphagia (p=0.11). Recurrent GERD (defined as resumption of PPI after successful initial post-operative wean) was less frequent after OD than after MHD, 3.6 versus 16.3%, p=0.006. Delayed onset dysphagia was 1.2% in the OD group versus 8.6% in the MHD group, p=0.04. Recurrent hiatal hernia of 2cm or greater occurred in 0.0% of the OD and 11.5% of the MHD, p=0.03. Repeat surgery for hiatal hernia repair has occurred in 0% of the OD and 6.6% of the MHD, p=0.02.ConclusionOD of the hiatus with crural closure resulted in less recurrence of reflux symptoms and hiatal hernia, despite an increased proportion of patients with larger hiatal hernia and more complex anatomic disease at the time of operation.
机译：背景：磁性括约肌扩张（MSA）设备最初植入在膈肌裂孔最小裂孔疝解剖（MHD）。由于如果疝入一种神秘的或小的食管裂孔疝，并加深理解到在胃食管反流病缺陷下肢的作用可能MSA设备功能障碍的关注，手术过程在时间改为间断的计划义务清扫（OD）所有implantations.MethodsBetween 2012年12月和2016年9月，182例患者接受MSA植入在一个单一的医疗中心，并有到九月2017年MHD解剖期延长，从2012年12月至2015年9月，可供查看完整的记录，从2015年9月至2016年所有患者后行OD.ResultsMHD发生53％（182分之96）与OD在47％（182分之86），平均随访时间在天MHD和OD为554（SD 427）与374（298）天。对于MHD与OD疝尺寸术测量为0.77（1.1）相对于3.95（2.4）厘米，P <0.001。在第一次随访中，有任何吞咽困难（P = 0.11）没有什么区别。复发性GERD（定义为PPI的恢复成功的初始手术后断奶后）为OD比MHD后后较不频繁，3.6对16.3％，P = 0.006。延迟发作吞咽困难是1.2％的OD组与MHD组中8.6％，p值=0.04英寸2厘米或更大的复发性食管裂孔疝发生在OD 0.0％和MHD的11.5％，P = 0.03。对于食管裂孔疝修补术重复发生在OD 0％和MHD，P =与脚部封闭裂孔的0.02.ConclusionOD导致反流症状及食管裂孔疝不易复发的6.6％，尽管患者比例增加较大的食管裂孔疝和更复杂的解剖疾病在操作时。

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  • 来源
    《Surgical Endoscopy》 |2019年第3期|共7页
  • 作者

    Tatum James M.; Alicuben Evan; Bildzukewicz Nikolai; Samakar Kamran; Houghton Caitlin C.; Lipham John C.;

  • 作者单位

    Univ Southern Calif Div Upper GI &

    Gen Surg Dept Surg Healthcare Consultat Ctr 4 Keck Sch Med;

    Univ Southern Calif Div Upper GI &

    Gen Surg Dept Surg Healthcare Consultat Ctr 4 Keck Sch Med;

    Univ Southern Calif Div Upper GI &

    Gen Surg Dept Surg Healthcare Consultat Ctr 4 Keck Sch Med;

    Univ Southern Calif Div Upper GI &

    Gen Surg Dept Surg Healthcare Consultat Ctr 4 Keck Sch Med;

    Univ Southern Calif Div Upper GI &

    Gen Surg Dept Surg Healthcare Consultat Ctr 4 Keck Sch Med;

    Univ Southern Calif Div Upper GI &

    Gen Surg Dept Surg Healthcare Consultat Ctr 4 Keck Sch Med;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    GERD; LINX; MSA; Magnetic sphincter augmentation; Hiatal hernia;

    机译：GERD;LINX;MSA;磁性括约肌增强;海拔疝气;

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