Novel combined VATS/laparoscopic approach for giant and complicated paraesophageal hernia repair: description of technique and early results

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• 作者：Daniela Molena (1)
  Benedetto Mungo (1)
  Miloslawa Stem (2)
  Anne O. Lidor (2)
  
  1. Division of Thoracic Surgery ; Department of Surgery ; Johns Hopkins University School of Medicine ; 600 N Wolfe Street ; Blalock 240 ; Baltimore ; MD ; 21287 ; USA
  2. Department of Surgery ; Johns Hopkins University School of Medicine ; Baltimore ; MD ; USA
  
• 关键词：Thoracoscopy ; Surgical ; Oesophageal ; Paraesophageal hernia ; Laparoscopy
• 刊名：Surgical Endoscopy
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：29
• 期：1
• 页码：185-191
• 全文大小：897 KB
• 参考文献：1. Draaisma WA, Gooszen HG, Tournoij E, Broeders IA (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19:1300鈥?308 CrossRef
  2. Bawahab M, Mitchell P, Church N, Debru E (2009) Management of acute paraesophageal hernia. Surg Endosc 23:255鈥?59 CrossRef
  3. Whitson BA, Hoang CD, Boettcher AK, Dahlberg PS, Andrade RS, Maddaus MA (2006) Wedge gastroplasty and reinforced crural repair: important components of laparoscopic giant or recurrent hiatal hernia repair. J Thorac Cardiovasc Surg 132(5):1196鈥?202.e3 CrossRef
  4. Cuschieri A, Shimi S, Nathanson LK (1992) Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg 163:425鈥?30 CrossRef
  5. Katkhouda N, Mavor E, Achanta K, Friedlander MH, Grant SW, Essani R, Mason RJ, Foster M, Mouiel J (2000) Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery 128:784鈥?90 CrossRef
  6. Hamrick MC, Davis SS, Chiruvella A, Coefield RL, Waring JP, Sweeney JF, Lin E (2013) Incidence of delayed gastric emptying associated with revisional laparoscopic paraesophageal hernia repair. J Gastrointest Surg 17:213鈥?17 CrossRef
  7. Mittal SK, Bikhchandani J, Gurney O, Yano F, Lee T (2011) Outcomes after repair of the intrathoracic stomach: objective follow-up of up to 5聽years. Surg Endosc 25:556鈥?66 CrossRef
  8. Mungo B, Molena D, Miloslawa S, Feinberg RL, Lidor AO (2014) 30-Day outcomes of paraesophageal hernia repair using NSQIP database: should laparoscopy be the standard of care? J Am Coll Surg. doi:10.1016/j.jamcollsurg.2014.02.030
  9. Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253:291鈥?96 CrossRef
  10. Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, Schuchert MJ (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 139:395鈥?04 404.e1 CrossRef
  11. Karmali S, McFadden S, Mitchell P, Graham A, Debru E, Gelfand G, Graham J, Martin S, Tiruta C, Grondin S (2008) Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes. Dis Esophagus 21:63鈥?8
  12. White BC, Jeansonne LO, Morgenthal CB, Zagorski S, Davis SS, Smith CD, Lin E (2008) Do recurrences after paraesophageal hernia repair matter? : ten-year follow-up after laparoscopic repair. Surg Endosc 22:1107鈥?111 CrossRef
  13. Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7:59鈥?7 CrossRef
  14. Horvath KD, Swanstrom LL, Jobe BA (2000) The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery. Ann Surg 232:630鈥?40 CrossRef
  15. Patel HJ, Tan BB, Yee J, Orringer MB, Iannettoni MD (2004) A 25-year experience with open primary transthoracic repair of paraesophageal hiatal hernia. J Thorac Cardiovasc Surg 127:843鈥?49 CrossRef
  16. Nguyen NT, Schauer PR, Hutson W, Landreneau R, Weigel T, Ferson PF, Keenan RJ, Luketich JD (1998) Preliminary results of thoracoscopic Belsey Mark IV antireflux procedure. Surg Laparosc Endosc 8:185鈥?88 CrossRef
  17. Arca MJ, Barnhart DC, Lelli JL Jr, Greenfeld J, Harmon CM, Hirschl RB, Teitelbaum DH (2003) Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 38:1563鈥?568 CrossRef
  18. Yang EY, Allmendinger N, Johnson SM, Chen C, Wilson JM, Fishman SJ (2005) Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome. J Pediatr Surg 40:1369鈥?375 CrossRef
  19. Dahlberg PS, Deschamps C, Miller DL, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 72:1125鈥?129 CrossRef
  20. Low DE, Unger T (2005) Open repair of paraesophageal hernia: reassessment of subjective and objective outcomes. Ann Thorac Surg 80:287鈥?94 CrossRef
  21. Mittal SK, Bikhchandani J, Gurney O, Yano F, Lee T (2011) Outcomes after repair of the intrathoracic stomach: objective follow-up of up to 5聽years. Surg Endosc 25:556鈥?66 CrossRef
  22. Lugaresi M, Mattioli S, Aramini B, D鈥橭vidio F, Di Simone MP, Perrone O (2013) The frequency of true short oesophagus in type II-IV hiatal hernia. Eur J Cardiothorac Surg 43:e30鈥揺36 CrossRef
  23. Oelschlager BK, Yamamoto K, Woltman T, Pellegrini C (2008) Vagotomy during hiatal hernia repair: a benign esophageal lengthening procedure. J Gastrointest Surg 12:1155鈥?162 CrossRef
  24. O鈥橰ourke RW, Khajanchee YS, Urbach DR, Lee NN, Lockhart B, Hansen PD, Swanstrom LL (2003) Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus. Arch Surg 138:735鈥?40 CrossRef
  25. Zehetner J, Demeester SR, Ayazi S, Kilday P, Alicuben ET, Demeester TR (2014) Laparoscopic wedge fundectomy for collis gastroplasty creation in patients with a foreshortened esophagus. Ann Surg. doi:10.1097/SLA.0000000000000504
  26. Nason KS, Luketich JD, Awais O, Abbas G, Pennathur A, Landreneau RJ, Schuchert MJ (2011) Quality of life after collis gastroplasty for short esophagus in patients with paraesophageal hernia. Ann Thorac Surg 92:1854鈥?860 CrossRef
  27. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481鈥?90
  28. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213:461鈥?68 CrossRef
  29. Oelschlager BK, Petersen RP, Brunt LM, Soper NJ, Sheppard BC, Mitsumori L, Rohrmann C, Swanstrom LL, Pellegrini CA (2012) Laparoscopic paraesophageal hernia repair: defining long-term clinical and anatomic outcomes. J Gastrointest Surg 16:453鈥?59 CrossRef
  30. Lidor AO, Kawaji Q, Stem M, Fleming RM, Schweitzer MA, Steele KE, Marohn MR (2013) Defining recurrence after paraesophageal hernia repair: correlating symptoms and radiographic findings. Surgery 154(2):171鈥?78 CrossRef
  31. Wassenaar EB, Mier F, Sinan H, Petersen RP, Martin AV, Pellegrini CA, Oelschlager BK (2012) The safety of biologic mesh for laparoscopic repair of large, complicated hiatal hernia. Surg Endosc 26:1390鈥?396 CrossRef
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gynecology
  Gastroenterology
  Hepatology
  Proctology
  Abdominal Surgery
  
• 出版者：Springer New York
• ISSN：1432-2218

文摘

Background The laparoscopic approach for repair of giant and/or recurrent paraesophageal hernias (PEH) is challenging, due to limited access to the dissection of the hernia sac into the proximal mediastinum and esophageal mobilization through the diaphragmatic hiatus. An esophageal lengthening procedure is often necessary, due to the difficulty in obtaining adequate intra-abdominal esophageal length. We, therefore, developed a VATS and laparoscopic technique, which allows for safe and extensive thoracic dissection and intra-abdominal gastric fixation and cruroplasty, yet preserving the benefits of minimally invasive surgery. Methods We use a standard VATS approach. The hernia sac, optimally visualized, is dissected posteriorly from the thoracic aorta, inferiorly from its diaphragmatic attachments, anteriorly from the pericardium, and laterally from the mediastinal pleura. The esophagus is completely mobilized up to the aortic arch, and the anterior vagus nerve is released from its bronchial branches. The hernia sac is then opened, dissected, and completely removed. The hernia content is then reduced into the abdomen laparoscopically, the short gastric vessels are divided and the gastric fundus is completely mobilized. The hiatus is closed with interrupted sutures, and the cruroplasty is buttressed with a biological mesh. A floppy Nissen or a partial fundoplication and a gastropexy are done for reflux control and gastric fixation. Results From January 2012 to January 2014, we treated 18 patients (7 with type III PEH and 11 with type IV) with the above-described procedure. Six patients had previous history of antireflux surgery. We performed a planned laparotomy instead of laparoscopy in two patients, who needed concurrent repair of complex incisional hernias. We did not need esophageal lengthening procedures, nor experienced damages to thoracic structures in any patient. Conclusions Our newly developed surgical approach has proven to be safe and feasible. This technique represents a good option for treatment of giant and complicated PEH.