PDF(Pubmed)
Abstract：
BACKGROUND: Hiatal Hernia (HH) is a common structural defect of the diaphragm. Laparoscopic repair with suturing of the hiatal pillars followed by fundoplication has become standard practice. In an attempt to lower HH recurrence rates, mesh reinforcement, commonly located at the posterior site of the esophageal hiatus, has been used. However, effectiveness of posterior mesh augmentation is still up to debate. There is a lack of understanding of the mechanism of recurrence requiring further investigation. We investigated the anatomic location of HH recurrences in an attempt to assess why HH recurrence rates remain high despite various attempts with mesh reinforcement.
METHODS: A retrospective case series of prospectively collected data from patients with hiatal hernia repair between 2012 and 2020 was performed. In total, 54 patients with a recurrent hiatal hernia operation were included in the study. Video clips from the revision procedure were analyzed by a surgical registrar and senior surgeon to assess the anatomic location of recurrent HH. For the assessment, the esophageal hiatus was divided into four equal quadrants. Additionally, patient demographics, hiatal hernia characteristics, and operation details were collected and analyzed.
RESULTS: 54 patients were included. The median time between primary repair and revision procedure was 25 months (IQR 13-95, range 0-250). The left-anterior quadrant was involved in 43 patients (80%), the right-anterior quadrant in 21 patients (39%), the left-posterior quadrant in 21 patients (39%), and the right-posterior quadrant in 10 patients (19%).
CONCLUSIONS: In this study, hiatal hernia recurrences occured most commonly at the left-anterior quadrant of the hiatus, however, posterior recurrences were not uncommon. Based on our results, we hypothesize that both posterior and anterior hiatal reinforcement might be a suitable solution to lower the recurrence rate of hiatal hernia. A randomized controlled trial using a circular, bio-absorbable mesh has been initiated to test our hypothesis.
METHODS: A retrospective case series of prospectively collected data from patients with hiatal hernia repair between 2012 and 2020 was performed. In total, 54 patients with a recurrent hiatal hernia operation were included in the study. Video clips from the revision procedure were analyzed by a surgical registrar and senior surgeon to assess the anatomic location of recurrent HH. For the assessment, the esophageal hiatus was divided into four equal quadrants. Additionally, patient demographics, hiatal hernia characteristics, and operation details were collected and analyzed.
RESULTS: 54 patients were included. The median time between primary repair and revision procedure was 25 months (IQR 13-95, range 0-250). The left-anterior quadrant was involved in 43 patients (80%), the right-anterior quadrant in 21 patients (39%), the left-posterior quadrant in 21 patients (39%), and the right-posterior quadrant in 10 patients (19%).
CONCLUSIONS: In this study, hiatal hernia recurrences occured most commonly at the left-anterior quadrant of the hiatus, however, posterior recurrences were not uncommon. Based on our results, we hypothesize that both posterior and anterior hiatal reinforcement might be a suitable solution to lower the recurrence rate of hiatal hernia. A randomized controlled trial using a circular, bio-absorbable mesh has been initiated to test our hypothesis.
摘要：
背景：食管疝（HH）是隔膜的常见结构缺陷。腹腔镜修复，缝合裂孔柱后进行胃底折叠术已成为标准做法。为了降低HH复发率，网格钢筋,通常位于食管裂孔的后部，已被使用。然而,后网格增强的有效性仍有争议。缺乏对复发机制的了解，需要进一步研究。我们调查了HH复发的解剖位置，以评估尽管进行了各种网状加固尝试，但HH复发率仍然很高的原因。
方法：对2012年至2020年间食管裂孔疝修补术患者的前瞻性数据进行回顾性病例系列研究。总的来说,该研究包括54例复发性食管裂孔疝手术患者。手术登记员和高级外科医生分析了翻修手术的视频剪辑，以评估复发性HH的解剖位置。对于评估，食管裂孔分为四个相等的象限。此外,患者人口统计学，食管裂孔疝的特点，和操作细节进行了收集和分析。
结果：纳入54例患者。初次修复和翻修手术之间的中位时间为25个月（IQR13-95，范围0-250）。43例患者（80%）累及左前象限，21例患者的右前半部分（39%），21例患者的左后象限（39%），和右后象限10例（19％）。
结论：在这项研究中，裂孔疝复发最常见于裂孔的左前象限，然而,后复发并不少见。根据我们的结果,我们假设食管裂孔的后端和前端强化术可能是降低食管裂孔疝复发率的合适解决方案.一项使用通告的随机对照试验，生物可吸收网已经开始检验我们的假设。
方法：对2012年至2020年间食管裂孔疝修补术患者的前瞻性数据进行回顾性病例系列研究。总的来说,该研究包括54例复发性食管裂孔疝手术患者。手术登记员和高级外科医生分析了翻修手术的视频剪辑，以评估复发性HH的解剖位置。对于评估，食管裂孔分为四个相等的象限。此外,患者人口统计学，食管裂孔疝的特点，和操作细节进行了收集和分析。
结果：纳入54例患者。初次修复和翻修手术之间的中位时间为25个月（IQR13-95，范围0-250）。43例患者（80%）累及左前象限，21例患者的右前半部分（39%），21例患者的左后象限（39%），和右后象限10例（19％）。
结论：在这项研究中，裂孔疝复发最常见于裂孔的左前象限，然而,后复发并不少见。根据我们的结果,我们假设食管裂孔的后端和前端强化术可能是降低食管裂孔疝复发率的合适解决方案.一项使用通告的随机对照试验，生物可吸收网已经开始检验我们的假设。
