PDF(Pubmed)
Abstract：
UNASSIGNED: A parahiatal hernia (PH) is a rare diaphragmatic hernia (DH) adjacent to but separated from the esophageal hiatus. The surgical repair for PH needs primary suture closure or complicated hernioplasty and the addition of an anti-reflux procedure. This report describes a case of PH with a symptomatic esophageal hiatal hernia managed using three-dimensional (3D) laparoscopy.
METHODS: A 65-year-old woman with back pain and breathlessness was referred to our hospital for a DH. Computed tomography showed a diaphragmatic defect on the left side of the esophageal hiatus. Upper gastrointestinal endoscopy and 24-hour esophageal impedance-pH monitoring showed a symptomatic esophageal hiatal hernia. Laparoscopic repair for both hernias was performed using 3D laparoscopy. The DH orifice was located in the left crus of the diaphragm, and it was separated from the esophageal hiatus. These findings showed that this DH was a PH. The PH was repaired with primary suturing, and a hiatoplasty was performed. Toupet fundoplication was performed with a 270° posterior wrap of the gastric fornix. The patient has remained asymptomatic a year after surgery without any complications.
UNASSIGNED: 3D laparoscopy provides significant advantages in surgeries requiring precise suturing. PH repairs require complex procedures, including mesh repair or suturing. Approximately 44 % of PH cases also necessitate fundoplication. 3D laparoscopy was useful for the present case.
CONCLUSIONS: A rare PH and a symptomatic type 1 hiatal hernia were repaired with 3D laparoscopy, which is helpful for PH treatment in cases requiring complicated procedures.
METHODS: A 65-year-old woman with back pain and breathlessness was referred to our hospital for a DH. Computed tomography showed a diaphragmatic defect on the left side of the esophageal hiatus. Upper gastrointestinal endoscopy and 24-hour esophageal impedance-pH monitoring showed a symptomatic esophageal hiatal hernia. Laparoscopic repair for both hernias was performed using 3D laparoscopy. The DH orifice was located in the left crus of the diaphragm, and it was separated from the esophageal hiatus. These findings showed that this DH was a PH. The PH was repaired with primary suturing, and a hiatoplasty was performed. Toupet fundoplication was performed with a 270° posterior wrap of the gastric fornix. The patient has remained asymptomatic a year after surgery without any complications.
UNASSIGNED: 3D laparoscopy provides significant advantages in surgeries requiring precise suturing. PH repairs require complex procedures, including mesh repair or suturing. Approximately 44 % of PH cases also necessitate fundoplication. 3D laparoscopy was useful for the present case.
CONCLUSIONS: A rare PH and a symptomatic type 1 hiatal hernia were repaired with 3D laparoscopy, which is helpful for PH treatment in cases requiring complicated procedures.
摘要：
■裂孔旁疝（PH）是一种罕见的膈疝（DH），与食管裂孔相邻但与之分离。PH的手术修复需要初次缝合或复杂的疝修补术，并增加抗反流程序。本报告描述了使用三维（3D）腹腔镜检查治疗的有症状的食管裂孔疝的PH病例。
方法：一名65岁的女性背痛和呼吸困难，被转诊到我们医院进行DH。计算机断层扫描显示食管裂孔左侧有膈缺损。上消化道内镜和24小时食管阻抗-pH监测显示有症状的食管裂孔疝。使用3D腹腔镜检查对两种疝进行腹腔镜修复。DH孔位于隔膜的左侧，它和食管裂孔分开了。这些发现表明该DH是PH。用初级缝合修复了PH,并进行了组织移植术。Toupet胃底折叠术是通过胃穹窿的270°后包裹进行的。患者在手术后一年仍无症状，无任何并发症。
■3D腹腔镜在需要精确缝合的手术中提供了显着优势。PH维修需要复杂的程序，包括网状修复或缝合。大约44%的PH病例也需要胃底折叠术。3D腹腔镜检查对本例有用。
结论：用3D腹腔镜修复了罕见的PH和有症状的1型食管裂孔疝，这对于需要复杂程序的PH治疗是有帮助的。
方法：一名65岁的女性背痛和呼吸困难，被转诊到我们医院进行DH。计算机断层扫描显示食管裂孔左侧有膈缺损。上消化道内镜和24小时食管阻抗-pH监测显示有症状的食管裂孔疝。使用3D腹腔镜检查对两种疝进行腹腔镜修复。DH孔位于隔膜的左侧，它和食管裂孔分开了。这些发现表明该DH是PH。用初级缝合修复了PH,并进行了组织移植术。Toupet胃底折叠术是通过胃穹窿的270°后包裹进行的。患者在手术后一年仍无症状，无任何并发症。
■3D腹腔镜在需要精确缝合的手术中提供了显着优势。PH维修需要复杂的程序，包括网状修复或缝合。大约44%的PH病例也需要胃底折叠术。3D腹腔镜检查对本例有用。
结论：用3D腹腔镜修复了罕见的PH和有症状的1型食管裂孔疝，这对于需要复杂程序的PH治疗是有帮助的。
