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腹腔镜路径食管裂孔疝修补术Laparoscopic Approach to Paraesophageal Hernia Repair

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腹腔镜路径食管裂孔疝修补术Laparoscopic Approach to Paraesophageal Hernia Repair
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腹腔镜下行食管裂孔疝修补及抗反流手术是目前主流的手术方式,本文介绍了腹腔镜下手术技术。

1.切口


Laparoscopic port placement for repair of a paraesophageal hernia

2.还原疝内容物,进入纵隔

Reduction of herniated abdominal contents into the abdomen and proper entry into the areolar plane of the mediastinum is performed by identifying the edge of the phrenoesophageal ligament,which has become attenuated.

3. 扩大纵膈解剖完成食管360度游离来完成重建正常结构

Complete 360 , transhiatal mobilization with extensive mediastinal dissection to re-establish normal anatomy. Careful attention is paid to maintaining the peritoneal lining of both crus to preserve its integrity.

4. 确定足够的无张力腹腔内食管长度并评估食管延长手术的必要性

The gastric fat pad is mobilized off of the esophagus and gastric cardia to identify the true gastroesophageal junction

5. 建立抗反流屏障

In the setting of a shortened esophagus, a wedge collis gastroplasty is performed (A–C). In (D), points A–D represent the line of the transected short gastric arteries of the neofundic tip that is grasped through the retroesophageal window and passed posterior to the esophagus for creation of the fundoplication, and a “shoeshine” maneuver performed to assess appropriate orientation of the wrap.

6. 重新缝合食管裂孔

Primary repair and reapproximation of the right and left crus is performed using the endostitch device.
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