Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation.
Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation.
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DOI：
10.1007/s00464-017-5859-4
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Heidrick R
中科院分区：
文献类型：
--
作者：
Buckley FP 3rd;Bell RCW;Freeman K;Doggett S;Heidrick R
食管下括约肌磁力增强术（MSA）可恢复食管裂孔疝≤3cm患者的抗反流屏障。我们进行了一项前瞻性研究，患者在修复食管旁疝和超过3cm轴向部分时使用LINX装置进行MSA。在2014年3月至2017年2月期间，通过腹腔镜疝修补和MSA治疗了200例患者（110名女性）。平均年龄59.5岁，平均BMI 29.4。40%食管炎，20%肠化生，77例中72例pH值异常。术前使用PPI的比例为87%。18例患者既往有裂孔疝/基底重叠。所有患者功能正常。78%的患者存在≥5 cm或较大的食管旁成分的轴裂孔疝。平均手术时间为81 min (38-193)， EBL为10 cc。83%的患者进行了非永久性补片补片修补。有两例因脱水而再次入院；肺栓塞2例，心脏缺血1例。19例患者需要扩张术。156名PTS随访时间中位数为8.6个月。GERD-HRQL评分从术前的26分提高到术后的2分。94%的患者实现了完全的PPI独立性（147/156）。51例患者中位11个月的视频食管造影发现3例< 3cm的无症状疝。一名有症状的患者在没有MSA操作的情况下成功修复了疝气。到目前为止，还没有设备外植、腐蚀或迁移。这项前瞻性研究对200例bbbb3 cm疝患者进行了MSA合并裂孔成形术，随访时间中位数为9个月，结果良好。与已发表的MSA治疗< 3cm疝的报道相比，MSA的安全性和临床疗效与最初的疝大小无关。
Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter restores the antireflux barrier in patients with hiatal hernias ≤3 cm. We performed a prospective study in patients undergoing MSA with the LINX device during repair of paraesophageal and hernias over 3 cm axial component. Multicenter, prospective study of consecutive patients treated with MSA at the time of repair of hiatal hernias >3 cm. 200 patients (110 female) were treated between March 2014 and February 2017 via laparoscopic hernia repair and MSA. Mean age was 59.5 years, mean BMI 29.4. 40% had esophagitis, 20% intestinal metaplasia, 72 of 77 tested had abnormal pH studies. Preoperative PPI use was reported by 87%. Eighteen patients had prior hiatal hernia/fundoplication. All had normal function. 78% of patients had axial hiatal hernia ≥5 cm or large paraesophageal component. Mean operative time was 81 min (38–193), EBL was 10 cc. Non-permanent mesh reinforcement of hiatal repair was performed in 83% of the patients. There were two readmissions for dehydration; 2 patients with pulmonary embolism, and 1 patient with cardiac ischemia. Nineteen patients required dilation. 156 pts were followed at a median of 8.6 months. GERD-HRQL scores improved from 26 preoperatively to 2 postoperatively. Complete PPI independence was achieved in 94% (147/156). Videoesophagram in 51 patients at median 11 months found 3 asymptomatic hernias <3 cm. One symptomatic patient underwent successful repair of the hernia without MSA manipulation. There have been no device explants, erosions, or migrations to date. This prospective study of 200 patients with >3 cm hernias undergoing MSA with hiatoplasty resulted in favorable outcomes with median of 9 months follow-up. Comparing this to published reports of MSA in patients with <3 cm hernias, the safety and clinical efficacy of MSA are independent of initial hernia size.
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DOI：
10.1016/s0022-5223(96)70319-7
发表时间：
1996-03-01
影响因子：
6
作者：
Fuller, CB;Hagen, JA;Bremner, CG
通讯作者：
Bremner, CG
DOI：
10.1007/s00464-006-0042-3
发表时间：
2006-11-01
影响因子：
3.1
作者：
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通讯作者：
Birkmeyer, John D.
影响因子：
3.2
作者：
Bonavina, Luigi;Saino, Greta I.;DeMeester, Tom
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DeMeester, Tom
影响因子：
7.7
作者：
Ganz, Robert A.;Gostout, Christopher J.;DeMeester, Tom R.
通讯作者：
DeMeester, Tom R.
影响因子：
9
作者：
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Aye, Ralph W.