ABSTRACT
Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Abdominal Wall , General Surgery , Esophageal Stenosis , Fundoplication , Methods , Heartburn , Hernia, Hiatal , Diagnosis , General Surgery , Laparoscopy , Methods , Pneumoperitoneum, Artificial , Postoperative ComplicationsABSTRACT
Complications related to CO2 pneumoperitoneum in laparoscopy surgery have led to the devel-opment of gasless laparoscopic surgery using abdominal wall lifting technique.The technique uses facilitate laparoseopic surgery without conventional pneumoperitoneum and markly reduced in the risks of anesthesiolo-gy,especially in old patients with cardiopulmonary insufficiency.The review summarizes the application of gasless laparoscopie surgery using abdominal wall lifting technique in the field of general surgery.
ABSTRACT
Objective To evaluate the value of gasless laparoscopic myomectomy(GLM)using a subcutaneous abdominal wall lifting system for leiomyomas.Methods The surgical outcomes,including operation time,intraoperative blood loss,recovery time of gastrointestinal function,hospital stay,complications,and cost of GLM using a subcutaneous abdominal wall lifting system(GLM group)and laparoscopic myomectomy with pneumoperitoneum(LM group)were compared.Results No intra-or post-operative complications occurred in both of the groups.No significant difference was found in the operation time and blood loss between the GLM and LM groups [(99.2?35.4)min vs.(102.7?28.8)min,t=-0.411,P=0.682;(77.0?48.3)ml vs.(89.6?53.8)ml,t=-0.940,P=0.351].While the GLM group had significantly shorter recovery time of gastrointestinal function and hospital stay [(1.8?0.5)d vs.(2.1?0.3)d,Mann-Whitney U=304.000,P=0.013;and(8.7?2.9)d vs.(10.3?3.1)d,t=-2.031,P=0.047],and lower cost [(6372.8?784.7)yuan vs.(7984.6?1048.7)yuan,t=-6.657,P=0.000].Conclusions Since GLM does no results in longer operation time and more blood loss than LM with pneumoperitoneum,it is suitable for large leiomyoma.The patients have quicker recovery,shorter hospital stay,and lower hospital cost after GLM.