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首页> 外文期刊>Surgical Endoscopy >Hiatal mesh is associated with major resection at revisional operation.
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Hiatal mesh is associated with major resection at revisional operation.

机译：食管裂孔在翻修手术时与大面积切除有关。

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BACKGROUND: Mesh-assisted hiatal closure during foregut surgery is increasing. Our aim was to evaluate the complications that follow revisional foregut surgery. Specifically, we compared surgical indications and perioperative outcomes between patients with and without prior hiatal mesh (PHM). METHODS: We conducted an institutional review board (IRB)-approved retrospective cohort study from a single tertiary-care referral center. Over 37 months, 91 patients underwent revisional foregut surgery. We excluded 13 cases including operations performed primarily for obesity or achalasia. Of the remaining 78 patients, 10 had PHM and 68 were nonmesh patients (NM). RESULTS: The groups were similar in terms of age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and rates and types of anatomic failure. Compared with NM patients, PHM patients had increased estimated blood loss (410 vs. 127 ml, p < 0.01) and operative time (4.07 vs. 2.89 h, p < 0.01). The groups had no difference in perioperative blood transfusion or length of stay. Complete fundoplication was more commonly created in NM patients (2/10 vs. 42/68, p = 0.03). Three of the 10 PHM patients and 3 of the 68 NM patients required major resection. Therefore, PHM patients had 6.8-fold increased risk of major resection compared with NM patients [95% confidence interval (CI) = 1.585, 29.17; p = 0.05]. The NM patients with multiple prior hiatal operations had 4.6-fold increased risk of major resection compared with those with one prior operation (95% CI = 2.919, 7.384; p = 0.03). In PHM patients, however, the number of prior hiatal operations was not associated with major resection. CONCLUSIONS: PHM is associated with increased risk of major resection at revision. The pattern of failure was not different in patients with hiatal mesh, suggesting that hiatal mesh does not eliminate the potential for revision. When performing hiatal herniorrhaphy, the increased risk of recurrence without mesh must be weighed against the potential risk for subsequent major resection when using mesh.
机译：背景：前肠手术期间网状裂孔的闭合越来越多。我们的目的是评估修订前肠手术后的并发症。具体来说，我们比较了有无食管裂孔（PHM）的患者的手术指征和围手术期结局。方法：我们进行了一项由机构审查委员会（IRB）批准的单一三级转诊中心的回顾性队列研究。在37个月内，有91例患者接受了前肠翻修术。我们排除了13例病例，包括主要针对肥胖症或ach门失弛缓症的手术。在其余的78位患者中，有10位患有PHM，68位是非网状患者（NM）。结果：各组在年龄，体重指数（BMI），美国麻醉医师学会（ASA）分类以及解剖衰竭的发生率和类型方面相似。与NM患者相比，PHM患者的估计失血量增加（410 vs. 127 ml，p <0.01）和手术时间增加（4.07 vs. 2.89 h，p <0.01）。各组围手术期输血或住院时间无差异。 NM患者更容易发生完全胃底折叠术（2/10 vs. 42/68，p = 0.03）。 10例PHM患者中的3例和68 NM患者中的3例需要大范围切除。因此，与NM患者相比，PHM患者的大手术风险增加了6.8倍[95％置信区间（CI）= 1.585，29.17; p = 0.05]。与进行过一次食管裂孔手术的NM患者相比，进行过一次食管裂孔手术的NM患者大手术风险增加了4.6倍（95％CI = 2.919，7.384; p = 0.03）。然而，在PHM患者中，先前的食管裂孔手术次数与大手术切除率无关。结论：PHM与修订时大手术风险增加相关。食管裂孔患者的失败模式没有不同，提示食管裂孔并不能消除翻修的可能性。进行食管裂孔疝修补术时，必须权衡不使用网状手术而增加的复发风险与使用网状手术进行后续大手术的潜在风险。

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