METHODS: We retrospectively reviewed all primary hiatal hernias (≥3 cm) repaired at a single center between 2010 and 2020. Patients with intraoperative hiatal photos with at least 1 year of follow-up were included. The hiatal openings were classified into 4 shapes: slit, inverted teardrop, \"D,\" and oval, and ordered in this manner of hypothesized increased complexity and tension.
RESULTS: A total of 239 patients were studied, with 113 (47%) having a recurrence. Age (P < .001), proportion of paraesophageal hernias (P < .001), hernia axial length (P < .001), and hiatal width (P < .001) all increased as shape progressed from slit to inverted teardrop to \"D\" to oval. Mesh (P = .003) and relaxing incisions (P < .001) were more commonly employed in more advanced shapes, \"D\" and ovals. However, recurrence (P = .88) did not correlate with hiatal shape.
CONCLUSIONS: Four different hiatal shapes are commonly seen during hernia repair. These shapes represent a spectrum of hernia chronicity and complexity necessitating increased use of operative measures but not correlating with recurrence. Despite failing to be a direct marker for recurrence risk, hiatal shape may serve as an intraoperative tool to inform surgeons of the potential need for additional hiatal interventions.
方法:我们回顾性回顾了2010-2020年间在单中心修复的所有原发性食管裂孔疝(≥3cm)。包括具有至少一年随访的术中食管裂孔照片的患者。裂孔分为四种形状:狭缝,倒泪珠,\"D\",和椭圆形,并以这种假设增加的复杂性和张力的方式有序。
结果:共研究了239例患者,113(47%)有复发。年龄(p<0.001),食管旁疝的比例(p<0.001),疝轴向长度(p<0.001),随着形状从狭缝到倒泪滴到“D”到椭圆形,裂孔宽度(p<0.001)都增加了。网格(p=0.003)和松弛切口(p<0.001)更常用于更高级的形状,“D”和椭圆形。然而,复发(p=0.88)与食管形态无关.
结论:在疝修补术中常见四种不同的食管形态。这些形状代表了一系列的疝慢性和复杂性,需要增加手术措施的使用,但与复发无关。虽然不能成为复发风险的直接标志,裂孔形状可以作为术中工具,告知外科医生可能需要额外的裂孔干预措施.