RESUMO
BACKGROUND: Delayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes. METHODS: Data collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery. RESULTS: Delayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery. CONCLUSION: Delayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.
Assuntos
Complexo Glicoproteico GPIIb-IIIa de Plaquetas/imunologia , Trombocitopenia/induzido quimicamente , Vancomicina/efeitos adversos , Adenocarcinoma/sangue , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Anticorpos Imobilizados , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Neoplasias do Colo/cirurgia , Transfusão de Eritrócitos , Evolução Fatal , Imunofluorescência , Humanos , Nefropatias/complicações , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Transfusão de Plaquetas , Complicações Pós-Operatórias/tratamento farmacológico , Neoplasias Retais/sangue , Neoplasias Retais/secundário , Neoplasias Retais/cirurgia , Trombose/etiologia , Vancomicina/farmacocinética , Vancomicina/uso terapêuticoRESUMO
Traditional treatment of short segment Hirschprungs disease in adult consists of major resectional procedures, often with the use of a temporary stoma. Patients with this disease may have significant morbidities that increase their risk of post-operative morbidity and mortality. In an attempt to minimize the procedural related morbidity, we describe the application of the stapled anopexy technique to treat short segment Hirschprungs disease.