Desetogodišnje iskustvo u hirurškom lečenju bolesnika sa hijatus hernijom

  • Milan S Korica Univerzitet u Novom Sadu, Medicinski Fakultet, Klinički Centar Vojvodine
  • Svetozar Sečen Clinical Center of Vojvodina, *Clinic for Abdominal, Endocrine and Transplantation Surgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Radovan Cvijanović Cvijanović Clinical Center of Vojvodina, *Clinic for Abdominal, Endocrine and Transplantation Surgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Nataša Nestorov Clinical Center of Vojvodina, Clinic for Anaesthesia and Intensive Therapy, Novi Sad, Serbia
  • Milan Stanković Clinical Center of Vojvodina, Clinic for Ortopedic Surgery and Traumathology, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Radovan Veljković Clinical Center of Vojvodina, Clinic for Abdominal, Endocrine and Transplantation Surgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP160728355K
Ključne reči: hernija, dijafragmalna;, hirurgija, operativne procedure;, hirurška mrežica;, lečenje, ishod.

Sažetak


Apstrakt

 

Uvod/Cilj. Najčešći benigni poremećaji gornjeg dela gastrointestinalnog trakta u današnje vreme su hijatus hernija i pridružena gastroezofagusna refluksna bolest (GERB). Cilj rada bio je da se prikažu rezultati laparoskopskog hirurškog lečenja hijatus hernije i GERB u traženju najboljeg tipa fundoplikacije za svakog pojedinačnog bolesnika. Metode. Studijom su obuhvaćena 132 bolesnika sa dijagnozom hijatus hernije operisana u periodu od maja 2004. do decembra 2014. godine na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju Kliničkog centra Vojvodine. Selekcija za hirurško lečenje izvršena je na osnovu nalaza ezofagogastroskopije, rendgena gastroduodenuma sa kontrastom, 24-časovnog pH monitoringa i ezofagealne manometrije. Rezultati. Kod svih bolesnika izvršena je posteriorna hijatoplastika direktnim suturama, a kod 21 (16%) bo­lesnika sa velikom hijatus hernijom, uz direktnu suturu dodato je ojačanje mrežicom. Ukupno je izvedeno 68 Nissen-ovih fundoplikacija, 59 Toupet-ovih i samo 5 Door-ovih fundoplikacija. Zadnjih godina se uglavnom primenjuje „short-floppy“ Nissen-ova fundoplikacija zbog dobrih postoperativnih rezultata. Od intraoperativnih komplikacija bile su prisutne: lezija parijetalne pleure (kod tri bolesnika), laceracija kapsule slezine (četiri bolesnika), minimalna povreda adventicije distalnog ezofagusa (kod jednog bolesnika) i termalna povreda fundusa želuca (jedan bolesnik). Od postoperativnih komplikacija zabeležena je jedna fistulizacija fundusa želuca, tranzitorni emfizem u predelu vrata (kod pet bolesnika), manji pleuralni izliv sa leve strane (kod šest bolesnika) i kod 23 (17,4%) bolesnika bila je prisutna tranzitorna disfagija. Stopa recidiva bila je 18,2% (kod 24 bolesnika). Desio se jedan fatalni ishod. Zaključak. La­paroskopska operacija se smatra bezbednom i uspešnom hirurškom procedurom u lečenju hijatus hernije. Hijatoplastika ojačana mrežicom preporučljiva je procedura u odabranim slučajevima. Posle adekvatne hijatoplastike preporučuje se primena dobro mobilisane „short flopy“ Nissenove fundoplikacije.

Reference

REFERENCES

Lundell L, Bell M, Ruth M. Systematic review: Laparoscopic fundoplication for gastroesophageal reflux disease in partial responders to proton pump inhibitors. World J Gastroenterol 2014; 20(3): 804‒13.

Hartono JL, Qua C, Goh K. Non-erosive reflux disease (NERD), symptomatic and asymptomatic erosive reflux disease (ERD): From hypersensitive to hyposensitive esophagus. Dig Dis Sci 2011; 56(1): 90‒6.

Brown SR, Gyawali PC, Melman L, Jenkins ED, Bader J, Frisella MM, et al. Clinical outcomes of atypical extra-esophageal ref-lux symptoms following laparoscopic antireflux surgery. Surg Endosc 2011; 25(12): 3852‒8.

Frazzoni M, Piccoli M, Conigliaro R, Frazzoni L, Melotti G. Lapa-roscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol 2014; 20(39): 14272‒9.

Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG. Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg 2010; 97(6): 845‒52.

Marano L, Schettino M, Porfidia R, Grassia M, Petrillo M, Esposito G, et al. The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia. BMC Surgery 2014; 14: 1.

Légner A, Tsuboi K, Bathla L, Lee T, Morrow LE, Mittal SK. Reoperative antireflux surgery for dysphagia. Surg Endosc 2011; 25(4): 1160‒7.

Schijven MP, Gisbertz SS, Van Berge Henegouwen MI. Laparoscopic surgery for gastro-esophageal acid reflux disease. Best Pract Res Clin Gastroenterol 2014; 28(1): 97‒109.

Jacobsen GR, Ducoin CG. Surgical intervention for the treatment of gastroesophageal reflux disease. Tech Gastro-intest Endosc 2015; 17(2): 70‒6.

Shaw JM, Bornman PC, Callanan MD, Beckingham IJ, Metz DC. Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: A prospective, randomized trial. Surg Endosc 2010; 24(4): 924‒32.

Targarona EM, Grisales S, Uyanik O, Balague C, Pernas JC, Trias M. Long-term outcome and quality of life after laparoscopic treatment of large paraesophageal hernia. World J Surg 2013; 37(8): 1878‒82.

Ayazi S, Leers JM, Oezcelik A, Abate E, Peyre CG, Hagen JA, et al. Measurement of gastric pH in ambulatory esophageal pH monitoring. Surg Endosc 2009; 23(9): 1968‒73.

Rajendra S, Sharma P. Barrett's Esophagus. Curr Treat Options Gastroenterol 2014; 12(2): 169‒82.

El Khoury R, Ramirez M, Hungness ES, Soper NJ, Patti MG. Symptom Relief After Laparoscopic Paraesophageal Hernia Repair Without Mesh. J Gastrointest Surg 2015; 19(11): 1938‒42.

Tam V, Winger DG, Nason KS. A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg 2016; 211(1): 226‒38.

Zaninotto G, Portale G, Costantini M, Fiamingo P, Rampado S, Guirroli E, et al. Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and dura-bility. World J Surg 2007; 31(11): 2177‒83.

Alicuben ET, Worrell SG, DeMeester SR. Impact of crural relax-ing incisions, Collis gastroplasty, and non-cross-linked human dermal mesh crural reinforcement on early hiatal hernia recur-rence rates. J Am Coll Surg 2014; 219(5): 988‒92.

Koetje JH, Irvine T, Thompson SK, Devitt PG, Woods SD, Aly A, et al. Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial. World J Surg 2015; 39(6): 1465‒73.

Daigle CR, Funch-Jensen P, Calatayud D, Rask P, Jacobsen B, Grantcharov TP. Laparoscopic repair of paraesophageal hernia with anterior gastropexy: A multicenter study. Surg Endosc 2015; 29(7): 1856‒61.

Soricelli E, Basso N, Genco A, Cipriano M. Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Surg Endosc 2009; 23(11): 2499‒504.

Lin DC, Chun CL, Triadafilopoulos G. Evaluation and manage-ment of patients with symptoms after anti-reflux surgery. Dis Esophagus 2015; 28(1): 1‒10.

Grubnik VV, Malynovskyy AV. Laparoscopic repair of hiatal hernias: New classification supported by long-term results. Surg Endosc 2013; 27(11): 4337‒46.

Furnée E, Hazebroek E. Mesh in laparoscopic large hiatal hernia repair: A systematic review of the literature. Surg Endosc 2013; 27(11): 3998‒4008.

Fan X, Snyder N. Prevalence of Barrett's esophagus in patients with or without GERD symptoms: Role of race, age, and gender. Dig Dis Sci 2009; 54(3): 572‒7.

Pfluke JM, Parker M, Bowers SP, Asbun HJ, Daniel SC. Use of mesh for hiatal hernia repair: A survey of SAGES members. Surg Endosc 2012; 26(7): 1843‒8.

Robinson B, Dunst CM, Cassera MA, Reavis KM, Sharata A, Swanstrom LL. 20 years later: Laparoscopic fundoplication durability. Surg Endosc 2015; 29(9): 2520‒4.

Mittal SK, Légner A, Tsuboi K, Juhasz A, Bathla L, Lee TH. Roux-en-Y reconstruction is superior to redo fundoplication in a subset of patients with failed antireflux surgery. Surg Endosc 2013; 27(3): 927‒35.

Durand L, De Antón R, Caracoche M, Covián E, Gimenez M, Fer-raina P, et al. Short esophagus: Selection of patients for surgery and long-term results. Surg Endosc 2012; 26(3): 704‒13.

Du X, Hu Z, Yan C, Zhang C, Wang Z, Wu J. A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC Gastroenterol 2016; 16(1): 88.

Objavljeno
2021/01/26
Broj časopisa
Vol. 75 Br. 7 (2018): Vojnosanit Pregl 2018; July Vol. 75 (No. 7)
Rubrika
Originalni članak