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Management of acute paraesophageal hernia.

机译：急性食管旁食管疝的处理。

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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/m(2) 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.
机译：背景：急性食管旁食管疝是一种外科急症，表现为突然的胸部或腹部疼痛，吞咽困难，呕吐，呕吐或严重贫血。严重者可出现呼吸衰竭或系统性败血症。这可能是由于胃扭转，嵌顿，绞窄，严重出血或穿孔引起的。传统上，这已经通过开放手术进行了治疗。这项研究的目的是开发一种管理算法，并评估腹腔镜方法在这些情况下的作用。方法：回顾性分析了2004至2007年间在彼得·洛维德中心（Peter Lougheed Center）接受食管旁食管疝手术的患者的病历。选择接受急诊手术的急性症状的患者进行研究。结果：确定了20例患者。 17例患者成功进行了腹腔镜修复，包括减少疝气含量，囊袋切除，结扎闭合和胃底折叠术（Dor或Nissen）。其中有15个是半紧急完成的。三例患者进行了开放式修复。一名患者由于缺血性胃穿孔和腹膜污染而转变为开放性。另一例患者进行了右胸切开术，随后因纵隔污染进行了剖腹手术。体重指数（BMI）为49 kg / m（2）的第三例患者被转换为VI型食管副食管疝。腹腔镜组的平均手术时间为190.5分钟，失血最少，术后平均住院天数为8.2天。没有明显的围手术期并发症。所有患者在短期随访中均耐受常规饮食。结论：腹腔镜修复急性食管旁疝是安全可行的，发病率和死亡率均较低。它为一群年老且患有多种医疗问题的患者提供了微创手术的所有好处。根据我们的经验，我们提倡腹腔镜技术修复无明显穿孔的急性食管旁食管疝。还建议一种管理算法。

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