减肥手术中同时进行的裂孔疝修补术:加固有区别吗?

IF 1.3 Q3 Medicine
C. Boru, P. Termine, P. Antypas, A. Iossa, M. C. Ciccioriccio, F. de Angelis, Alessandra Micalizzi, G. Silecchia
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引用次数: 1

摘要

背景:裂孔疝修补术(HHR)在减肥手术中仍然存在争议,特别是在腹腔镜袖式胃切除术(LSG)的情况下。目的:报告合并HHR的长期结果,评估单纯或增强生物合成可吸收Bio-A®补片的后胆囊成形术(PC)的安全性和有效性(Gore, USA)。主要终点:PC失败,定义为有症状的HH复发,对药物治疗无反应,需要翻修手术。方法检索2011-2019年在某卓越中心进行的1876例减肥手术的前瞻性数据库,以寻找伴随的HHR。术中常规测量裂孔表面积(HSA)。结果共有250例患者接受了减肥手术并伴有HHR(13%)。单纯PC (A组,151例)共行130例LSG, 5例复套,16例胃旁路;平均BMI为43.4±5.8 kg/m2, HSA平均体型为3.4±2 cm2。强化PC (B组)99例:原发LSG 62例,LGB 22例,改型LSG 15例;平均BMI为44.6±7.7 kg/m2, HSA平均体型为6.7±2 cm2。单纯PC组12例(8%)出现胸内移位(ITM),强化PC组仅4例(4%)出现胸内移位(p=0.23);因此,所有病例均在腹腔镜下进行重复强化PC和R-en-Y胃旁路术(LRYGB)。围手术期或长期随访(平均50个月)均未出现补片相关并发症。术后4年无杯状细胞的心脏化生1例;转换为LRYGB,并对PC进行了强化重做。Cox风险分析显示,使用4针以上的结肠镜成形术是复发的不利因素(HR = 8;P < 0.05)。结论:在任何减肥手术中积极寻找和修复HH似乎是可取的,可以降低HH的复发率。其他措施,如用生物合成、可吸收的补片补片加强脚闭合,似乎可以改善长期随访的结果,特别是在裂孔缺陷较大的情况下。根据我们的经验,在肥胖人群中,加强更小的缺陷似乎是可取的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Concomitant hiatal hernia repair during bariatric surgery: does the reinforcement make the difference?
BACKGROUND Hiatal hernia repair (HHR) is still controversial during bariatric procedures, especially in case of laparoscopic sleeve gastrectomy (LSG). AIMS to report the long-term results of concomitant HHR, evaluating the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with biosynthetic, absorbable Bio-A® mesh (Gore, USA). Primary endpoint: PC's failure, defined as symptomatic HH recurrence, nonresponding to medical treatment and requiring revisional surgery. METHODS the prospective database of 1876 bariatric operations performed in a center of excellence between 2011-2019 was searched for concomitant HHR. Intraoperative measurement of the hiatal surface area (HSA) was performed routinely. RESULTS A total of 250 patients undergone bariatric surgery and concomitant HHR (13%). Simple PC (group A, 151 patients) was performed during 130 LSG, 5 re-sleeves and 16 gastric bypasses; mean BMI 43.4 ± 5.8 kg/m2, HSA mean size 3.4 ± 2 cm2. Reinforced PC (group B) was performed in 99 cases: 62 primary LSG, 22 LGB and 15 revisions of LSG; mean BMI 44.6 ± 7.7 kg/m2, HSA mean size 6.7 ± 2 cm2. PC's failure, with intrathoracic migration (ITM) of the LSG was encountered in 12 cases (8%) of simple vs. only 4 cases (4%) of reinforced PC (p=0.23); hence, a repeat, reinforced PC and R-en-Y gastric bypass (LRYGB) was performed laparoscopically in all cases. No mesh-related complications were registered perioperatively or after long-term follow-up (mean 50 months). One case of cardiac metaplasia without goblet cells was detected 4 years postoperatively; conversion to LRYGB, with reinforced redo of the PC was performed. The Cox hazard analysis showed that the use of more than four stitches for cruroplasty represents a negative factor on recurrence (HR = 8; p < 0.05). CONCLUSIONS An aggressive search for and repair of HH during any bariatric procedure seems advisable, allowing a low HH recurrence rates. Additional measures, like mesh reinforcement of crural closure with biosynthetic, absorbable mesh, seem to improve results on long term follow-up, especially in case of larger hiatal defects. In our experience, reinforcement of even smaller defects seems advisable in obese population.
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来源期刊
Minerva chirurgica
Minerva chirurgica 医学-外科
CiteScore
1.40
自引率
0.00%
发文量
0
审稿时长
>12 weeks
期刊介绍: Minerva Chirurgica publishes scientific papers on surgery. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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