Name: laparoscopic repair of para-esophageal hernia using absorbable biosynthetic mesh
Uploaded: 2021-09-11T13:00:00
Description: Watch this Scientific Journal Video about Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh at JoVE.com

作者没有承认。

该协议遵循作者机构人类研究伦理委员会（西南卫生区）的指导方针。
1. 术前准备
<ol><li>将患者置于低热量高蛋白营养饮食一周，以减少肝脏大小，并促进改善获得间歇性气喘的机会。</li>
	<li>在全身麻醉下，将患者置于利托切除术中，并逆转特伦德伦堡位置。</li>
	<li>术中，开具第一代头孢菌素预防（2克）静脉注射抗生素和深静脉血栓预防的抗凝剂。</li>
</ol><p class="jove_ti...

<ol>
	<li>Sathasivam, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mesh+hiatal+hernioplasty'+versus+'suture+cruroplasty'+in+laparoscopic+para-oesophageal+hernia+surgery;+a+systematic+review+and+meta-analysis.">Mesh hiatal hernioplasty' versus 'suture cruroplasty' in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis.</a> Asian Journal of Surgery. 42 (1), 53-60 (2018).</li><li>Olson, M. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+paraesophageal+hernia+repair+with+Gore&#174;+Bio-A&#174;+tissue+reinforcement:+long-term+outcomes+and+association+of+BMI+and+recurrence.">Primary paraesophageal hernia repair with Gore&#174; Bio-A&#174; tissue reinforcement: long-term outcomes and association of BMI and recurrence.</a> Surgical Endoscopy. 32 (11), 4506-4516 (2018).</li><li>K&#246;ckerling, F., Schug-Pass, C., Bittner, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+word+of+caution:+never+use+tacks+for+mesh+fixation+to+the+diaphragm.">A word of caution: never use tacks for mesh fixation to the diaphragm.</a> Surgical Endoscopy. 32 (7), 3295-3302 (2018).</li><li>Asti, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Crura+augmentation+with+Bio-A&#174;+mesh+for+laparoscopic+repair+of+hiatal+hernia:+single-institution+experience+with+100+consecutive+patients.">Crura augmentation with Bio-A&#174; mesh for laparoscopic repair of hiatal hernia: single-institution experience with 100 consecutive patients.</a> Hernia. 21 (4), 623-628 (2017).</li><li>Berselli, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+repair+of+voluminous+symptomatic+hiatal+hernia+using+absorbable+synthetic+mesh.">Laparoscopic repair of voluminous symptomatic hiatal hernia using absorbable synthetic mesh.</a> Minimally Invasive Therapy and Allied Technology. 24 (6), 372-376 (2015).</li><li>Priego, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+results+and+complications+related+to+Crurasoft((R))+mesh+repair+for+paraesophageal+hiatal+hernias.">Long-term results and complications related to Crurasoft((R)) mesh repair for paraesophageal hiatal hernias.</a> Hernia. 21 (2), 291-298 (2017).</li><li>Alicuben, E. 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C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+laparoscopic+port+site+hernias+in+gastrointestinal+surgery.">A systematic review of laparoscopic port site hernias in gastrointestinal surgery.</a> Surgeon. 9 (4), 218-224 (2011).</li><li>Kohn, G. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+management+of+hiatal+hernia.">Guidelines for the management of hiatal hernia.</a> Surgical Endoscopy. 27 (12), 4409-4428 (2013).</li><li>Luketich, J. 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副食管气喘修复的关键步骤包括端口放置、气喘囊的完全切除、腹内食管加长、两个迷走神经的识别、十字体的创伤网状加固以及胃成形术的前置资金。
此协议突出了仅使用一个助手的 4 端口方法（一个摄像头、三个工作端口）。安全窒息是通过在帕尔默点插入维雷斯针来实现的。光学无叶片访问系统用于放置摄像机端口，该端口通过左侧中位切口插入，该切口距离成本边?...

最近对副食管气喘修复的元分析审查得出结论，网眼加固是优越的，与缝合修复1相比，复发率较低。然而，由于研究的异质性，首选类型的网格仍然具有争议性。审查中包括的一些定义不一致，不仅对副食管气喘（要么在术前确定，要么在术中确定）或气喘复发（这些定义基于症状或调查），而且未指明的后续损失。这份手稿突出了使用生物合成网成功地修复了大间歇性气喘。
最常见的生物合成网由67%的聚甘油酸和33%的碳酸三甲基组成。这种假肢在6个月内逐渐被吸收，取而代之的是血管化软组织和胶原蛋白。这种生物合成网在395名患者中进行了研究，在这项大型研究中，16.1%的患者在24个月（范围，2-69个月）时出现复发症状，7.3%的患者有客观复发2。只有一名患者有严重的术后并发症（食管狭窄），需要皮内窥镜胃切除管插入，随后，在44个月内再手术，不再复发。类似的较小研究报告症状复发率从0%-9%，客观复发率0.9%-25%，和再操作范围从0%-10%4，5，6，7，8。没有一项研究报告与网状相关的并发症。
下面详细的协议是对一名68岁的女性进行的，该女性在以前的 幽 门螺杆菌胃炎和NSAID诱发的胃溃疡中，表现出一年没有对医疗和缺铁性贫血反应迟钝的严重反流症状。术前胃镜检查显示卡梅隆的溃疡，胃体大线性侵蚀和10厘米滚动间歇性气喘（相比之下，在一年前的上一次胃镜检查4厘米）。胸部CT扫描证实了胸腔内半食管气喘的诊断。

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			<td height="21" style="height:21px;width:221px;">1.0 non-absorbable suture</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td style="width:171px;"></td>
		</tr>
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			<td height="21" style="height:21px;width:221px;">10 mm port</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">3.0 absorbable suture</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">5mm port</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Biosynthetic mesh</td>
			<td style="width:125px;">GORE BIO-A</td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:221px;">Bladeless optical access entry system</td>
			<td style="width:125px;">Kii</td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Drain&#160;</td>
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			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Fibrin glue</td>
			<td style="width:125px;">Tiseel</td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Laparoscopic grasper</td>
			<td style="width:125px;">Ethicon</td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Laparoscopic harmonic&#160; scalpel</td>
			<td style="width:125px;">Ethicon</td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Nathan liver retractor</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Sling</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:221px;">Veress needle</td>
			<td style="width:125px;"></td>
			<td style="width:165px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

laparoscopic repair of para-esophageal hernia using absorbable biosynthetic mesh

食管气喘修复是具有挑战性的程序，没有就最佳修复方法达成共识。与初级缝合修复相比，网状加固与较小的气喘复发有关。最合适的网格类型仍然是有争议的。文献中对合成材料和生物合成材料进行了研究。有据可查，合成网与食管侵蚀和胃部迁移有关。虽然生物合成网的长期数据有限，但短期结果良好且前景广阔。
本文阐述了生物合成假肢如何安全地用于纤维蛋白胶固定和前Dor基金修复任何副食管缺陷。与传统方法（包括合成网修复）相比，可吸收的生物合成网已证明能产生良好的长期患者满意度结果和低复发率。该技术还可以避免食道侵蚀的风险，同时加强修复。由于患心脏棉布或其他灾难性后果的相关风险，仍然广泛用于保护网状物的钉子可能会被丢弃。这种修复方法也突出了假肢如何被塑造成V形，并很容易地放置在食道后面的内嵌方式。该协议演示了使用纤维蛋白胶水进行网格固定的替代和安全方法。

术后病人仍然无症状。分别在4个月、12个月和24个月进行常规胃镜检查，发现心食管结仍然位于距离牙科商场38厘米的地方，没有早期复发或反流食道炎的证据。有轻微的胃炎的蚂蚁。
该技术已在32名患者中使用可吸收的生物合成网进行。只有一名患者报告并发症（表1）。
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<td>使用此?...

Watch this Scientific Journal Video about Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh at JoVE.com

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh

这里展示的是一个副食管气喘修复协议。使用可吸收的生物合成网，可避免通过食道侵蚀的风险，同时加强修复。胶水固定是首选，以避免创伤的风险，如出血或心脏棉布，这与缝线或钉。

使用可吸收的生物合成网格对副食管气喘进行拉帕罗镜修复

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been ...

这是一个视频显示腹腔镜网修复一个大，定义为大于7厘米长，滑动中断气喘使用戈尔生物A网。这位患者现年68岁，出现反流症状，对医疗反应迟钝，缺铁性贫血。随后的胃镜检查发现卡梅隆病变，胃体大线性侵蚀和10厘米滚动间歇性气喘，相比之下，一年前的上一次胃镜检查有4厘米。手术前，患者接受Optifast一周治疗，以缩小肝脏大小，并在术中协助肝脏切除。在帕尔默的点上，通过左下骨维雷斯针建立12毫米汞的苯丙胺。定义为左中线下半价边距以下三厘米。使用直接无叶片光学访问输入系统，插入端口，这是超高，一只手跨度从成本边距和相机的中线左侧。通过一个小的左半伤寒切口，用内森森肝脏缩回器提升肝脏的左叶。将另外两个五毫米的端口置于摄像机端口旁边的直接视野下。一个在右中线的水平。左前辅助线上的第二个端口。插入一个10毫米的端口，在左中线更头孢子，以创建一个理想的工作三角测量。在这个阶段，大部分胃会被咬伤到媒体上。因此，从助手处连续牵引，将被监禁的胃拉回腹腔，以观察胃食管结。在胃肝韧带的面膜松弛水平上输入较小的曲率，并使用烧灼逐步解剖、减少和切除气喘囊。这将导致两个隔膜十字军逐渐暴露。注意是由劣质的静脉卡瓦和肝脏的果叶相对于正确的十字军。通过在间歇中分离所有先天性寄生食道粘合剂来周游地调动食道。继续从双边十字军中动员间歇性气喘，以帮助将气喘囊收回到腹腔。识别和保存迷走神经和两个普鲁拉。在食道和胸主动脉之间创建一个后窗，并在食道周围放置胶带，以便轻轻缩回。近身调动远食道，距离约10厘米，直到有足够的腹内食管长度，即约3至4厘米，因此食道没有紧张。近似隔膜十字与三或四个中断的1-O不可吸收编织缝合线，并加强修复与预形生物合成网，这是引入食道后面的内嵌方式。网状物的右边缘应滑到肝脏的叶下。如有必要，将左三角韧带分开以容纳网状。如果面包屑的质量和张力足够，则不需要认捐。十字军闭合的程度不应导致下食道变窄或压缩。充分关闭的粗略指南是能够通过一个掌握者通过剩余的差距。用四兆二醇的纤维蛋白胶水固定生物合成网格。使用 2O 不可吸收的编织缝合线进行修改的 180 度前 Dor fundoplic，将胃结钉向左十字，然后连续将胃的折叠较大曲率前固定到隔膜上，然后一直固定到近右十字。通常需要四条缝合线。将网格融入第一条缝合线中。在募捐过程中注意不要伤害围花。不使用布吉。插入封闭式吸力消耗。用皮下3-O合成可吸收和单丝缝合线关闭皮肤。术后，患者头部抬高至30度，以避免吸入。病人被置于常规的抗磁学。病人可以一夜之间喝一口水，如果耐受的话，可以喝上清澈的液体。排水沟通常在两天后被移除。建议患者在四到六周内进行纯饮食。结果。32名患者接受了这项技术。其中26人为女性，6人为男性。随访中位数为19个月。这一群体的平均年龄为72岁。在这32名患者中，4名为1型，均大于7厘米，23名为3型，其中3名为复发型，最后4名为4型。在这些患者中，有一例复发和一例死亡。这个病人有复发性三型间歇性气喘，这是一个困难的解剖。术后，这个病人在最初的48小时内身体很好，耐受性很好。然后，她意外地迅速从未被承认的心脏棉布中解还。结论。此过程的要点包括一个，完整和周密的动员与囊切除的间歇性气喘。二、充分暴露和克拉修复。三、用生物合成网加固十字形。四、进一步加固维修，修改后的180度前多芬。使用此技术，可以实现低复发率。但是，患者应进行定期内窥镜检查的持续随访。还鼓励更健康的生活方式。

Research

JoVE Journal

Medicine

A Contusive Model of Unilateral Cervical Spinal Cord Injury Using the Infinite Horizon Impactor

单侧颈脊髓损伤的挫伤模型，利用无限的地平线冲击

While the majority of human spinal cord injuries occur in the cervical spinal cord, the vast majority of laboratory research employs animal models of ...

科研

医学

Repair of a Critical-sized Calvarial Defect Model Using Adipose-derived Stromal Cells Harvested from Lipoaspirate

修复的临界大小的颅骨缺损模型脂肪间充质干细胞的收获Lipoaspirate

Craniofacial skeletal repair and regeneration offers the promise of de novo tissue formation through a cell-based approach utilizing stem cells. ...

Development of an Algorithm to Perform a Comprehensive Study of Autonomic Dysreflexia in Animals with High Spinal Cord Injury Using a Telemetry Device

一个算法的开发与高位脊髓损伤使用遥测装置进行自主神经异常反射的动物的综合研究

Spinal cord injury (SCI) is a debilitating neurological condition characterized by somatic and autonomic dysfunctions. In particular, SCI above the ...

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

Laparoscopic Technique for Serial Collection of Liver and Mesenteric Lymph Nodes in Macaques

腹腔镜技术在猕猴肝和肠系膜淋巴结的串行采集

The mesenteric lymph nodes (MLN) and the liver are exposed to microbes and microbial products from the gastrointestinal (GI) tract, making them ...

Transvaginal Mesh Insertion in the Ovine Model

经阴道网格插入在牛模型中

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided ...

In Vitro Assays to Assess Blood-brain Barrier Mesh-like Vessel Formation and Disruption

In Vitro Assays to Assess Blood-brain Barrier Mesh-like Vessel Formation and Disruption

评估血脑屏障网状血管形成和破坏的体外测定

Blood-brain barrier (BBB) coverage plays a central role in the homeostasis of the central nervous system (CNS). The BBB is dynamically maintained by ...

Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy

操作横向主动脉收缩与可吸收的缝合获得瞬时心肌萎缩

Based on twice transverse aortic constrictions (TACs) in mice, it is proved that myocardial hypertrophic preconditioning (MHP) could attenuate ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

在卵巢子宫内膜异位症腹腔镜膀胱切除术期间优化卵巢储备的手术技术

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

腹腔镜胰十二指肠切除术使用原 位 非接触式隔离技术治疗胰腺癌

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic ...