Abstract：
BACKGROUND: Esophageal hiatal hernia (EHH) presenting after gastrectomy for carcinoma is a type of internal hernia and very rare. There have been no published reports on the use of hand-assisted laparoscopic surgery (HALS) for the treatment of an incarcerated EHH that presented after a gastrectomy. Herein, we report a rare case of HALS performed for an incarcerated EHH presenting after a laparoscopic gastrectomy.
METHODS: This case report presents the case of a 66-year-old man who underwent hernia repair for an incarcerated hernia that presented after he underwent a laparoscopic proximal gastrectomy with double-tract reconstruction for cancer in the esophagogastric junction. Emergency laparoscopic hernia repair was performed and herniation of the transverse colon into the left thoracic cavity through a hiatal defect was confirmed. Since it was difficult to return the transverse colon into the abdominal cavity using forceps, the procedure was converted to HALS and the transverse colon was pulled back into the abdominal cavity. The hernia defect was closed using a non-absorbable suture. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day.
CONCLUSIONS: The HALS approach provides the tactile experience of an open surgery combined with the benefits of a laparoscopic procedure such as good visualization and low invasiveness. In this case, when the transverse colon that had herniated into the left hemithorax was returned to the abdominal cavity, damage to the transverse colon was avoided by using the hand. Hence, HALS was safely performed to repair an incarcerated EHH after gastrectomy.
METHODS: This case report presents the case of a 66-year-old man who underwent hernia repair for an incarcerated hernia that presented after he underwent a laparoscopic proximal gastrectomy with double-tract reconstruction for cancer in the esophagogastric junction. Emergency laparoscopic hernia repair was performed and herniation of the transverse colon into the left thoracic cavity through a hiatal defect was confirmed. Since it was difficult to return the transverse colon into the abdominal cavity using forceps, the procedure was converted to HALS and the transverse colon was pulled back into the abdominal cavity. The hernia defect was closed using a non-absorbable suture. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day.
CONCLUSIONS: The HALS approach provides the tactile experience of an open surgery combined with the benefits of a laparoscopic procedure such as good visualization and low invasiveness. In this case, when the transverse colon that had herniated into the left hemithorax was returned to the abdominal cavity, damage to the transverse colon was avoided by using the hand. Hence, HALS was safely performed to repair an incarcerated EHH after gastrectomy.
摘要：
背景：胃癌切除术后出现的食管裂孔疝（EHH）是一种内部疝，非常罕见。尚无关于使用手助腹腔镜手术（HALS）治疗胃切除术后出现的嵌顿EHH的公开报道。在这里，我们报道了一例罕见的因腹腔镜胃切除术后出现嵌顿EHH而进行HALS的病例.
方法：本病例报告介绍了一例66岁的男性患者，该患者在接受腹腔镜近端胃切除术和双道重建治疗食管胃交界处癌症后接受了嵌顿疝修补术。进行了紧急腹腔镜疝修补术，并确认了横结肠通过食管缺损进入左胸腔。由于使用镊子很难将横结肠返回腹腔，将手术转换为HALS，并将横结肠拉回腹腔。使用不可吸收的缝合线闭合疝缺损。术后进展顺利，患者在术后第4天出院。
结论：HALS方法提供了开放手术的触觉体验，并结合了腹腔镜手术的优点，例如良好的可视化和低侵入性。在这种情况下,当突出进入左半胸腔的横结肠回到腹腔时，用手避免了对横结肠的损伤。因此，胃切除术后安全地进行HALS以修复嵌顿的EHH。
方法：本病例报告介绍了一例66岁的男性患者，该患者在接受腹腔镜近端胃切除术和双道重建治疗食管胃交界处癌症后接受了嵌顿疝修补术。进行了紧急腹腔镜疝修补术，并确认了横结肠通过食管缺损进入左胸腔。由于使用镊子很难将横结肠返回腹腔，将手术转换为HALS，并将横结肠拉回腹腔。使用不可吸收的缝合线闭合疝缺损。术后进展顺利，患者在术后第4天出院。
结论：HALS方法提供了开放手术的触觉体验，并结合了腹腔镜手术的优点，例如良好的可视化和低侵入性。在这种情况下,当突出进入左半胸腔的横结肠回到腹腔时，用手避免了对横结肠的损伤。因此，胃切除术后安全地进行HALS以修复嵌顿的EHH。
