背景:由于手术技术和网片组成的差异很大,腹腔镜食管旁疝修补术中的网片增强的颅骨成形术仍存在争议。这项研究旨在回顾腹腔镜食管旁疝修补术(LPEHR)后的结果和复发率,该修补术采用可吸收网片在单个机构中进行网状增强的结膜成形术。
方法:对所有接受LPEHR的患者进行回顾性分析。对患者报告的医疗记录进行了审查,复发的影像学或内窥镜证据,定义为>2厘米的垂直胸内胃。如果没有可供审查的研究,患者被认为没有复发.结果和网格相关的并发症也进行了审查。
结果:在2008年10月至2021年9月之间,473例患者接受了可吸收网状物的LPEHR;1.3%的2型疝,3型疝占86.0%,12.7%的4型疝。使用了三种类型的网格:最初是生物网格(n=83),然后是重量级合成生物可吸收网状物(n=261),最后是轻质合成生物可吸收网状物(n=111)。在年龄上没有显著差异,ASA,BMI,性别,吸烟状况,长期使用类固醇,术前抑酸,疝类型,或组间复发的疝气。术后30天的结果没有显着差异。反流症状指数,GERD-HRQL,和吞咽困难在术后1年和2年时间点的评分没有显着差异。总复发率为16.7%,生物学之间的复发率没有显着差异,重型或轻质生物合成可吸收网眼通过2年手术后。更短的中位复发时间(10个月,在轻量级组中观察到p=0.016)。
结论:LPEHR采用可吸收网状增强的结壳成形术是可行且安全的,与患者报告的结果相同,包括吞咽困难,长达2年POSTOP无论网格的选择。生物学之间的复发率没有显着差异,重量级,或轻质合成生物可吸收网眼在LPEHR后长达2年。
Mesh reinforced cruroplasty during laparoscopic paraesophageal hernia repair remains controversial due to wide variation in surgical technique and mesh composition. This study aims to review outcomes and rates of recurrence following laparoscopic paraesophageal hernia repair (LPEHR) with mesh reinforced cruroplasty utilizing absorbable mesh at a single institution.
A retrospective review of all patients who underwent LPEHR with mesh was performed. Medical records were reviewed for patient reported, radiographic or endoscopic evidence of recurrence, defined as > 2 cm of vertical intrathoracic stomach. If no studies were available for review, patients were considered to have no recurrence. Outcomes and mesh-related complications were also reviewed.
Between 10/2008 and 9/2021, 473 patients underwent LPEHR with absorbable mesh; 1.3% type 2 hernias, 86.0% type 3 hernias, 12.7% type 4 hernias. Three types of mesh were used: initially biologic mesh (n = 83), then heavyweight synthetic bioabsorbable mesh (n = 261), and finally lightweight synthetic bioabsorbable mesh (n = 111). There were no significant differences in age, ASA, BMI, gender, smoking status, chronic steroid use, preoperative acid suppression, hernia type, or recurrent hernia between groups. There were no significant differences in 30-day postoperative outcomes. Reflux Symptom Index, GERD-HRQL, and Dysphagia Scores at 1- and 2-year postoperative timepoints were not significantly different. The overall recurrence rate was 16.7%, with no significant differences in recurrence rates between biologic, heavyweight or lightweight biosynthetic absorbable mesh through 2 years after surgery. A shorter median time to recurrence (10 months, p = 0.016) was seen in the lightweight group.
LPEHR with absorbable mesh reinforced cruroplasty is feasible and safe, with equivalent patient-reported outcomes, including dysphagia, up to 2-years postop regardless of mesh choice. No significant differences in recurrence rates between biologic, heavyweight, or lightweight synthetic bioabsorbable mesh were seen up to 2 years after LPEHR.