Résumé
With the development of laparoscopic surgery for gastric cancer, more and more surgeons use laparoscopic techniques and even totally laparoscopic techniques in gastric cancer surgery. However, technological progress brings not only smaller trauma, but also new problems and risks. Compared with traditional open surgery, the high incidence of internal hernia after laparoscopic gastric cancer surgery is an urgent problem to be solved. As the incidence of internal hernia often occurs after discharge, patients usually choose the nearest hospital for diagnosis and treatment due to the urgent course of disease. As a result, patients with internal hernia often have serious complications due to delayed treatment because of the difficulty in diagnosis. Sometimes, there are patients even death. The authors review the relevant research on postoperative internal hernia of gastric cancer in recent years and combine with practical experience to discuss the diagnosis and treatment strategy of internal hernia after laparoscopic surgery for gastric cancer, aiming to improve the clinicians′ attention to the disease and provide reference for its diagnosis and treatment.
Résumé
@#Objective To explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia. Methods We divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups. Results There was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741). Conclusion The operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
Résumé
Objective To explore the perioperative nursing of elderly patients undergoing esophageal hiatal hernia repair with laparoscope. Method Twenty elderly patients undergoing esophageal hiatal hernia repair with laparoscope were managed with holistic nursing and the key nursing points were summarized. Results After operations, 3 of them contracted with dysphagia, 5 with weakened gastrointestinal motility, 6 with pulmonary infections, 3 with dyspnea and 1 with thrombus in the deep veins of lower extremities. All the 20 patients got recovered successfully after pertinent treatments. 3 months follow-ups showed the clinical symptoms disappeared and barium meal showed no relapse of hernias. Conclusion Strengthened perioperative nursing of operations on esophageal hiatal hernia is beneficial for postoperative recovery and reduction of postoperative complications.
Résumé
ObjectiveTo explore the safety and therapeutic effect of 8 patients with esophageal Hiatal Hernia treated by laparoscopic hernia repair.MethodsA retrospective analysis was performed on the clinical data of 8 patients with esophageal Hiatal Hernia form Jun.2009 to Jun. 2010.Among the participants,3 conducted 360-degree fundoplication,5 conducted partial(270-degree) fundoplication.Silk sutures were used for the repair of esophageal perforation in 4 patients,and patch repair was used for the other 4 cases.ResultsEight patients were treated by laparoscopic hernia repair,and all of them were cured without postoperative complications.The mean duration of surgery was ( 120 ± 30) min,with average blood loss ( 50 ± 12 ) ml.Patients had a mean postoperative hospital stay of(4.5 ± 2.5 )days.All the patients were followed up for 1 to 2 years,and no case was found to be relapsed.ConclusionTotal laparoscopic hernia repair is minimally invasive,with short recovery course,less pain after surgery,little complication and short hospitalized time.Laparoscopic Hernia repair should be the preferred effective operation method for patients with esophageal Hiatal Hernia.
Résumé
This study was to appraise safety and feasibility of laparoscopic approach and investigate the clinical effects of laparoscopic tension-free repair of esophageal hiatal hernia using mesh.From August 2006 to July 2009,24 patients with esophageal hiatal hernia underwent laparoscopic repair.Twenty-three patients received laparoscopic tension-free repair using mesh,at the same time,Toupet or Dor partial fundoplication was performed.One patient was converted to open surgery.The average operating time was 90 min (70-210 min) and the blood loss was between 10-110 mL.There was no death.The mean postoperative hospital stay was 5 days (3-30 days).During a follow-up period of 12-20 months (mean 15 months),there was no recurrence of the hernia,and no complication with use of mesh.The present study suggested that laparoscopic approach was secure and minimally invasive operation for esophageal hiatal hernia and the use of mesh could reduce recurrence rate.
Résumé
Objective To investigate the efficacy and safety of laparoscopic repair in children with congenital esophageal hiatal hernia. Methods From September 2001 to December 2008,seven children with congenital esophageal hiatal hernia,including 4 boys and 3 girls,were treated by laparoscopic repair and Nissen's fundoplication in our hospital. One of them received laparoscopic pyloroplasty in the meanwhile because of delayed gastric emptying (confirmed by preoperative gastrointestinal angiography); one child underwent laparoscopic high ligation due to right oblique inguinal hernia; spleneolus was found in one patient,no further treatment was carried out. Results The procedures were completed in all of the patients without conversion to open surgery. The mean operation time was 94.2 min (75-150 min) in this series,and the average blood loss was 5 ml (2-10 ml). No patient received blood transfusion after the surgery. The children began to intake milk or regular diet in 24-48 hours after the operation. They were discharged from hospital in a mean of 4.5 days (ranged from 3 to 7 days). Then,the children were followed up for 6 to 20 months (mean,12.6 months). One of the patients suffered from vomiting on the 10th day after the operation,1 patient showed recurrence in 1 year postoperation and then was cured by a second operation. The other five patients were healthy during the follow-up. Conclusions Laparoscopic repair of congenital esophageal hiatal hernia is a safe,effective,and minimally invasive procedure. It is feasible for patients complicated with other diseases. The indications for the surgery must be strictly selected.
Résumé
Objective To investigate the clinical effects of laparoscopic repair of esophageal hiatal hernia using Bard CruraSoft PTFE/ePTFE Mesh combined with Toupet partial fundoplication.Methods From August 2006 to April 2007,13 patients with esophageal hiatal hernia(typeⅠin 6 and type Ⅲ in 7)were treated by laparoscopy in our hospital.Under a laparoscope,esophageal hiatal hernia was separated by ultrasonic scalpel,and then repaired using Bard CruraSoft PTFE/ePTFE Mesh with Ethicon Endopath Multifieed Stapler.Afterwards,Toupet partial fundoplication was performed.Results The operation was completed in all the cases without converting to open surgery.The mean operation time was 142 min(115-185 min);mean intraoperative blood loss was 75 ml(25-120 ml);mean time to the first flatus and oral feeding was 32 h(26-37 h);and mean postoperative hospital stay was 4 d(3-6 d).The patients were followed up for 4-11 mon(mean 6.5 mon).The symptoms disappeared in 1 month.Three months after the operation,barium examination found no recurrence of the hernia in the 13 cases.Conclusions Laparoscopic repair of esophageal hiatal hernia with mesh combined with Toupet partial fundoplication is a safe and minimally invasive operation.The method is worth being widely used.
Résumé
Objective To summarize the clinical experience of laparoscopic repair of esophageal hiatal hernia.Methods A total of 15 cases of esophageal hiatal hernia underwent laparoscopic hernia repair and fundoplication from May 2004 to April 2005 in this division.There were 4 cases of type Ⅰ hernia(all of which presented severe gastroesophageal reflux disease),10 cases of type Ⅱ hernia,and 1 case of type Ⅲ.Surgical procedures included laparoscopic Nissen total fundoplication in 9 cases,Toupet partial fundoplicatin in 4 cases,and Dor partial fundoplication in 2.Symptoms of gastroesophageal reflux disease,including heart burn,dysphagia,regurgitation,chest pain,and belching,were evaluated by using the Visual Analogue Scales(VAS) at preoperative period,1 postoperative month,and 6 postoperative months,respectively.Results No conversion to open surgery was required in this study.The operative time ranged 100~187 min(mean,125 min).The postoperative hospital stay was 2~5 days(mean,2.8 days).All the patients were followed for 1~12 months(mean,8.5 months).No hernia recurrence was found.The VAS scores decreased from 5.0?3.9 preoperatively to 0.9?1.3 at 1 month postoperatively(t=3.823,P
Résumé
The esophageal hiatal hernia is a herniation of an abdominal organ, usually the stomach, through the esophageal hiatus into thoracic cavity. It is a rare disease, usually congenital and frequently associated with gastroesophageal reflux and other congenital malformations in children. It is classified according to their anatomic characteristics as type I (sliding hiatal hernia), type II (paraesophageal hiatal hernia), type III (combined hiatal hernia) and type IV (multiorgan hiatal hernia). We experienced a case of type III congenital esophageal hiatal hernia simulating chest mass on simple chest x-ray because of right intrathoracic stomach secondary to congenital esophageal hiatal hernia and organoaxial rotation in 10 months male. After the operation, he showed an improved general condition and was discharged at the 14th hospital day. We report the case with the brief review of the related literatures.