Laparoscopic surgery into mixed hiatal hernia. Results pre-operative and post-operative.

INTRODUCTION: The complications of the mixed hernia need, often, surgical treatment. In the asymtomatic patients this one treatment is controversial, due to her complex repair and the high percentage of relapse informed in the long term. The surgical classic routes, they present raised morbi-mortality related to the extent of the incisions, to long hospitable stays and slow recovery. MATERIAL AND METHODS: Between October, 2001 to November, 2007 we check 39 patients with hernia hiatal mixed with a middle ages of 65 years (35-78 years). In Lloyd-Davies s position, the content diminishes hernia and the redundant sack is resected. The diaphragmatic props are sutured by material not reabsorbable. Mesh of reinforcement intervened in 7/39 repairs. It concludes with a partial or complete antirreflux depending on the report. RESULTS: The operative average time was of 126 min; the hospital stay of 2.46 days. The complications perioperatives are principally cardiorespiratory. A patient died for an intestinal inadvertent perforation during the intervention and of late diagnosis. We realize traffic gastroduodenal to 12 months in 28 patients (71.7%). We find relapse in 8 patients (20.5%). Four asymtomatic patients, with chance find in the radiological control. Three patients with pirosis that needs treatment and one of the relapses needed reintervention for strangulation of a gastric volvulus. CONCLUSIONS: The laparoscopic surgery offers safety and efficiency with rapid postoperatory recovery, minor morbidity and hospitable stay. After the surgery, the long-term relapse presents similar results to the opened surgery, though the interposition of mesh can propitiate her decrease.

Tratamiento quirúrgico laparoscópico en la hernia de hiato mixta. Resultados peroperatorios y del seguimiento a medio plazo / Laparoscopic surgery into mixed hiatal hernia. Results pre-operative and post-operative

Introducción: las complicaciones de la hernia mixta requieren,con frecuencia, tratamiento quirúrgico. En los pacientes asintomáticoseste tratamiento es controvertido, debido a su complejareparación y al elevado porcentaje de recidivas informado a largoplazo. Las vías quirúrgicas clásicas presentan elevada morbimortalidadrelacionada con la amplitud de las incisiones, con largas estanciashospitalarias y lenta recuperación.Material y métodos: entre octubre de 2001 a noviembre de2007 revisamos 39 pacientes con hernia hiatal mixta con unaedad media de 65 años (35-78 años). En posición de Lloyd-Davies,se reduce el contenido herniario y se reseca el saco redundante.Se suturan los pilares diafragmáticos con material no reabsorbible.Se interpuso malla de refuerzo en 7/39 reparaciones. Sefinaliza con un antirreflujo parcial o completo dependiendo del informemanométrico.Resultados: el tiempo operatorio medio fue de 126 min. Laestancia hospitalaria de 2,46 días. Las complicaciones perioperatoriasson principalmente cardiorrespiratorias. Un paciente falleciópor una perforación intestinal inadvertida durante la intervencióny de diagnóstico tardío. Realizamos tránsito gastroduodenal alos 12 meses en 28 pacientes (71,7%). Encontramos recidiva en8 pacientes (20,5%). Cuatro pacientes asintomáticos, con hallaz-go casual en el control radiológico. Tres pacientes con pirosis querequiere tratamiento y una de las recidivas precisó reintervenciónpor estrangulación de un vólvulo gástrico.Conclusiones: la laparoscopia ofrece seguridad y eficacia conrápida recuperación postoperatoria, menor morbilidad y estanciahospitalaria. Tras la cirugía, la recidiva a largo plazo presenta similaresresultados a la cirugía abierta, aunque la interposición demalla puede propiciar su disminución(AU)

Introduction: the complications of the mixed hernia need, often,surgical treatment. In the asymtomatic patients this one treatmentis controversial, due to her complex repair and the high percentageof relapse informed in the long term. The surgical classicroutes, they present raised morbi-mortality related to the extent ofthe incisions, to long hospitable stays and slow recovery.Material and methods: between October, 2001 to November,2007 we check 39 patients with hernia hiatal mixed with amiddle ages of 65 years (35-78 years). In Lloyd-Davies's position,the content diminishes hernia and the redundant sack is resected.The diaphragmatic props are sutured by material not reabsorbable.Mesh of reinforcement intervened in 7/39 repairs. Itconcludes with a partial or complete antirreflux depending on thereport.Results: the operative average time was of 126 min; the hospitalstay of 2.46 days. The complications perioperatives are principallycardiorespiratory. A patient died for an intestinal inadvertentperforation during the intervention and of late diagnosis. Werealize traffic gastroduodenal to 12 months in 28 patients(71.7%). We find relapse in 8 patients (20.5%). Four asymtomaticpatients, with chance find in the radiological control. Three patientswith pirosis that needs treatment and one of the relapsesneeded reintervention for strangulation of a gastric volvulus.Conclusions: the laparoscopic surgery offers safety and efficiencywith rapid postoperatory recovery, minor morbidity andhospitable stay. After the surgery, the long-term relapse presentssimilar results to the opened surgery, though the interposition ofmesh can propitiate her decrease(AU)