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Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature

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World Journal of Gastroenterology 2013年第33期19卷 5528-5533页

作者： Wei Zhang Wei Tang Cheng-Xiang Shan Sheng Liu Zhi-Guo Jiang Dao-Zhen Jiang Xiang-Min Zheng Ming Qiu Department of General Surgery of Changzheng Hospital affiliated to the Second Military Medical University Department of Surgery University of Tokyo Hospital

AIM:To summarize our experience in the application of Crurasoft for antireflux surgery and hiatal hernia(HH)repair and to introduce the work of Chinese doctors on this topic.METHODS:Twenty-one patients underwent HH repair with Crurasoft reinforcement.Gastroesophageal reflux disease(GERD)and HH-related symptoms including heartburn,regurgitation,chest pain,dysphagia,and abdominal pain were evaluated preoperatively and 6mo postoperatively.A patient survey was conducted by phone by one of the authors.Patients were asked about"recurrent reflux or heartburn"and"dysphagia".An internet-based Chinese literature search in this field was also performed.Data extracted from each study included:number of patients treated,hernia size,hiatorrhaphy,antireflux surgery,follow-up period,recurrence rate,and complications(especially dysphagia).RESULTS:There were 8 typeⅠ,10 typeⅡand 3 typeⅢHHs in this group.Mean operative time was 119.29min(range 80-175 min).Intraoperatively,length and width of the hiatal orifice were measured,(4.33±0.84and 2.85±0.85 cm,respectively).Thirteen and eight Nissen and Toupet fundoplications were performed,respectively.The intraoperative complication rate was9.52%.Despite dysphagia,GERD-related symptoms improved significantly compared with those before surgery.The recurrence rate was 0%during the 6-mo follow-up period,and long-term follow-up disclosed a recurrence rate of 4.76%with a mean period of 16.28mo.Eight patients developed new-onset dysphagia.The Chinese literature review identified 12 papers with213 patients.The overall recurrence rate was 1.88%.There was no esophageal erosion and the rate of dysphagia ranged from 0%to 24%.CONCLUSION:The use of Crurasoft mesh for HH repair results in satisfactory symptom control with a low recurrence rate.Postoperative dysphagia continues to be an issue,and requires more research to reduce its incidence.

关键词： hiatal hernia Gastroesophageal reflux disease Anti-reflux surgery Mesh Prosthetic

Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundoplication, Esophagomyotomy, and hiatal Hernia Repair

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Surgical Science 2012年第1期3卷 1-9页

作者： Franziska Huettner Robin A. Alley Jamie L. Doubet Michael J. Ryan Danuta I. Dynda David L. Crawford Department of Radiology University of Michigan Hospital Ann Arbor USA Division of Minimally Invasive Surgery Department of Surgery College of Medicine University of Illinois at Peoria Illinois Medical Center Peoria USA Division of Plastic Surgery Department of Surgery University of Alabama at Birmingham Birmingham UK

Purpose: The purpose of the study was to review a single surgeon, seven-year experience, using the Da Vinci Telerobotic system performing 124 foregut operations. Methods: Data review from 2002-2009 including 71 Nissen fundoplications, 26 esophagomyotomies, and 27 hiatal hernia repairs was performed. Parameters collected included gender, age, body mass index (BMI), estimated blood loss (EBL), port set up time (PST), robot operating time (ROT), total case time (TCT), length of stay (LOS), complications, conversions, and resident involvement. Statistical analysis was con-ducted. Results: 124 foregut operations: 45 males, 79 females, mean age of 54.8 ± 16.7 (18 - 85) years, mean TCT 174.4 ± 45.0 (102 - 321) min. Nissen fundoplication: mean BMI of 30.8 ± 3.9 (22.4 - 46.8) kg/m2, EBL 30.2 ± 21.8 (5 - 100) ml, PST 32.3 ± 9 (14 - 63) min, ROT 111.4 ± 37.3 (51 - 229) min, TCT 175.0 ± 46.4 (102 - 321) min, median LOS 1 (0 - 9) day, complication rate 7.0% (5/71), conversion rate 5.6%, resident involvement 69.0% (49/71). Esophagomyotomy: mean BMI of 26.5 ± 6.1 (15.4 - 36.6) kg/m2, EBL 39.1 ± 41.7 (10 - 200) ml, PST 28.0 ± 8.6 (16 - 47) min, ROT 122.9 ± 45 (31 - 217) min, and TCT 178.0 ± 40.5 (105 - 262) min, median LOS 1 (0 - 6) day, complication rate 15.4% (4/26), conversion rate 0%, resident involvement 69.2% (18/26). hiatal hernia repair: mean BMI of 28.4 ± 4.2 (21.9 - 36.8) kg/m2, EBL 38.4 ± 32.7 (10 - 150) ml, PST 28.8 ± 8.0 (17 - 52) min, ROT 109.0 ± 44.5 (49 - 250) min, and TCT 169.2 ± 46.5 (102 - 299) min, median LOS 1 (1 - 14) day, complication rate 11.1% (3/27), conversion rate 3.7%, resident involvement 66.7% (18/27). Conclusion: Robotic-assisted foregut surgery is safe and effective. This series compares favorably with other robotic studies in length of hospital stay, total case time, and complication and conver-sion rates. Foregut surgery is an excellent robotic training ground for residents.

关键词： Robot Foregut Nissen Fundoplication hiatal Hernia Esophagomyotomy

Laparoscopic repair of complete intrathoracic stomach with iron deficiency anemia:A case report

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World Journal of Clinical Cases 2020年第6期8卷 1180-1187页

作者： Duolikun Yasheng Wubulikasimu Wulamu Yi-Liang Li Airexiati Tuhongjiang Kelimu Abudureyimu Department of Minimally Invasive Surgery Hernia and Abdominal Wall SurgeryPeople’s Hospital of Xinjiang Uygur Autonomous RegionUrumqi 830001Xinjiang Uygur Autonomous RegionChina Department of Gastrointestinal Surgery The University of Hong Kong-Shenzhen HospitalShenzhen 518053Guangdong ProvinceChina

BACKGROUND Giant paraesophageal hiatal hernias(HH)are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been reported.For the surgical treatment of large HH,Nissen fundoplication is the most common antireflux procedure,and the reinforcement of HH repair with a patch(either synthetic or biologic)is still debatable.CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia.After performing a series of tests and diagnostic approaches,results showed a complete intrathoracic stomach associated with severe iron deficiency anemia.The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication.Postoperatively,reflux symptoms were markedly relieved,and the imaging study showed complete reduction of the hernia sac.More importantly,anemia was resolved,and hemoglobin,serum iron and ferritin level were returned to the normal range.The patient kept regular follow-up appointments and remained in a satisfactory condition.CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia.For the surgical treatment of large HH,laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.

关键词： Complete intrathoracic stomach Giant paraesophageal hiatal hernia Iron deficiency anemia Nissen fundoplication Mesh reinforcement Case report

Gastroesophageal reflux: the features in elderlypatients

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World Journal of Gastroenterology 1999年第5期5卷 421-423页

作者： Huang X Zhu HM Deng CZ Porro GB Sangaletti O Pace F Shenzhen Peoples Hosp Dept Gastroenterol Shenzhen 518001 Guangdong Prov Peoples R China Univ Milan Gastrointestinal Unit Milan Italy

AIM To compare the features ofgastroesophageal reflux disease between elderlyand younger patients.METHODS Twenty-four hour pH-monitoring andendoscopy were P6rformed for the 66 elderlypatients with typical gastroesophageaI refluxsymptoms, and the results were compared with112 symptomatic younger patients.RESULTS The results of 24-h pH-monitoringand endoscopy showed that the elderly patientshad pathological reflux and reflux esophagitismore frequently than the younger patients.P6rcentage time with pH< 4 in elderly patientswith reflux esophagitis was 32.5% in 24 hours,as compared with 12.9% in the younger patientswith reflux esophagitis (P < 0 .05 ). The elderlypatients with reflux esophagitis have longerP6riOds of acid reflux in both upright and Supinepositions than the younger patients. Endoscopyshowed that 20 .8% of elderIy patients had grade Ⅲ / Ⅳ esophagitis, whereas only 3.4% ofyounger patients had grade Ⅲ/ Ⅳ esophagitis(P < 0.002 ). Percentages of grades Ⅰ /Ⅱesophagitis in the two groups were 12.5% and26. 5%, respectiveIy (P< 0. 002 ).CONCLUSION Elderly patients, as comparedwith younger patients, have more severegastroesophageal reflux and esophageal lesions.The incompetence of lower esophageal sphincter and the presence of hiataI hernia may beimportant factors leading to the difference in incidence and severity of reflux esophagitisbetween elderly and younger patients.

关键词： gastroesophageal reflux esophagitis hiatal hernia

Laparoscopic management of totally intra-thoracic stomach with chronic volvulus

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World Journal of Gastroenterology 2013年第35期19卷 5848-5854页

作者： Toygar Toydemir Gkhan Cipe Oguzhan Karatepe Mehmet Ali Yerdel Department of General Surgery Istanbul Surgery Hospital Department of General Surgery Medical School of Bezmialem Vak f University

AIM:To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus(IGV)and to assess the preoperative work-up.METHODS:A retrospective review of a prospectively collected database of patient medical records identified14 patients who underwent a laparoscopic repair of IGV.The procedure included reduction of the stomach into the abdomen,total sac excision,reinforced hiatoplasty with mesh and construction of a partial fundoplication.All perioperative data,operative details and complications were recorded.All patients had at least 6 mo of follow-up.RESULTS:There were 4 male and 10 female patients.The mean age and the mean body mass index were 66years and 28.7 kg/m2,respectively.All patients presented with epigastric discomfort and early satiety.There was no mortality,and none of the cases were converted to an open procedure.The mean operative time was235 min,and the mean length of hospitalization was 2 d.There were no intraoperative complications.Four minor complications occurred in 3 patients including pleuraleffusion,subcutaneous emphysema,dysphagia and delayed gastric emptying.All minor complications resolved spontaneously without any intervention.During the mean follow-up of 29 mo,one patient had a radiological wrap herniation without volvulus.She remains symptom free with daily medication.CONCLUSION:The laparoscopic management of IGV is a safe but technically demanding procedure.The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.

关键词： Laparoscopic procedure hiatal hernia Stomach Volvulus Mesh repair

Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett's esophagus

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World Journal of Gastroenterology 2015年第29期21卷 8974-8980页

作者： Atsushi Shiozaki Hitoshi Fujiwara Hirotaka Konishi Osamu Kinoshita Toshiyuki Kosuga Ryo Morimura Yasutoshi Murayama Shuhei Komatsu Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Kazuma Okamoto Chouhei Sakakura Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine

Barrett's esophagus(BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE(LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach(LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of thearch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 m L of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.

关键词： Laparoscopic transhiatal approach Barrett'sesophageal carcinoma hiatal hernia

Terminal ileum gangrene secondary to a type Ⅳ paraesophageal hernia

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World Journal of Gastroenterology 2016年第8期22卷 2642-2646页

作者： Ching Tsai Hsu Po Jen Hsiao Chih Chien Chiu Jenq Shyong Chan Yee Fung Lin Yuan Hung Lo Chia Jen Hsiao Department of Internal Medicine Taoyuan Armed Forces General Hospital Tri-Service General Hospital National Defense Medical Center Division of Nephrology Department of Internal Medicine Taoyuan Armed Forces General Hospital Division of General Surgery Department of Surgery Taoyuan Armed Forces General Hospital Division of Gastroenterology Department of Internal Medicine Taoyuan Armed Forces General Hospital

Type Ⅳ paraesophageal hernia(PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type Ⅳ PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in Pub Med. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type Ⅳ PEH with incarceration of only the terminal ileum.

关键词： Gangrene hiatal Ileum Paraesophageal hernia Thoracic cavity

^(99)Tc同位素扫描诊断食管裂孔疝及GER的临床观察

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中华小儿外科杂志 1989年第6期10卷 327-328,插1页

作者：李心元王慧贞李正权重碌刘中标潘杰中国医科大学附属第二、三医院小儿外科中国医科大学附属第二、三医院核医学科

本文采用^(99)Tc同位素扫描对12例食管裂孔疝行术前和术后检查.结果证明^(99)Tc同位素扫描可确定GER的程度.这对术式的选择,术后疗效的评定都是一项客观指标.同时还介绍了同位素扫描对GER的诊断,评价,食管裂孔疝与GER的关系.

关键词：同位素扫描诊断食管裂孔疝临床观察 operation gastroesophageal reflux hiatal hernia diagnosis of 术后疗效术后检查客观指标 used in degree 证明术式评定结果关系

Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum:A case report and review of the literature

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World Journal of Gastrointestinal Surgery 2013年第6期5卷 202-206页

作者： Tarkan Jger Daniel Neureiter Clemens Nawara Adam Dinnewitzer Dietmar fner Wolfram Lamadé Department of Surgery Paracelsus Medical University5020 SalzburgAustria Institute of Pathology Paracelsus Medical University/Salzburger Landeskliniken5020 SalzburgAustria Department of Surgery Helios Spital88662 überlingenGermany

Transhiatal herniation of the pancreas is an extremely rare condition.In the published literature we found only eleven cases reported in the period of 1958 to 2011.A coincidental hiatal herniation of the duodenum is described in two cases only.To our knowledge,we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis.A 72-yearold Caucasian woman was admitted to our department with a hiatal hernia grade Ⅳ for further evaluation.According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum,we had to respect the declared intention of the patient for a conservative procedure.So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition.We discuss the therapeutic decision making process and a complete literature review of this rare entity.

关键词： hiatal hernia Paraesophageal hernia Intrathoracic pancreas Intrathoracic duodenum Diaphragmatic hernia