Clinical Observation Of Laparoscopic Hiatal Hernia Repair And Fundoplication In The Treatment Of Hiatal Hernia And Gastroesophageal Reflux Disease

ObjectiveTo compare the efficacy of laparoscopic hiatal herniarepair combining with Nissen’s,Toupet’s and Dor’s operation in the treatment of hiatal hernia and gastroesophageal reflux disease and research on the advantages of each operation.Methods215 cases in 2013~2016 from Huiji Hospital of the First Affiliated Hospital of Zhengzhou University and cooperation unit were collected.All patients underwent hiatal hernia repair and anti-reflux procedure in three ways,including Nissen’s operation in 60 cases,Toupet’s operation in 83 cases,Dor’s operation in 72 cases.Three groups of patients with their general situation,operation time,postoperative complications,and the analysis of standard reference data 3 months before surgery,3 months and 6 months after surgery,including: gastroesophageal reflux disease symptoms score(Gerd-Q score),the results of 24 hour esophageal Ph impedance monitoring,multi-channel high resolution esophageal manometry and the results of electronic gastroscopy.ResultsThree groups of patients were followed up for 3~36 months(mean,13 months).There were no significant differences in age,sex,BMI,the course of reflux symptoms,the duration of PPI medication and the average length of stay.The duration of Dor’s operation was significantly shorter than that of the other two surgical operations,and the results were significant(P<0.05).Compared with the other two groups,the odds of abdominal distension and dysphagia after Nissen’s operation were significantly higher than those of the other two operations,and the results were statistically significant(P=0.005,P=0.004).Comparison of the analysis indicators standard: three groups of patients were followed up with the GERD-Q scores 3 months after the operation,and checked esophageal Ph impedance monitoring,multi-channel high resolution esophageal manometry and electronic gastroscopy 6 months after the operation.Compared with preoperative,the GERD-Q scores of three groups of patients after surgery for 3 months,were significantly reduced(P<0.05),and the effects of the operations among the three groups were with no difference(P=0.149).The results of esophageal manometry,esophageal acid test and gastroscopy of three groups of patients 6 months after the operation were significantly improved compared with preoperative(P<0.05),and there was no significant difference between the three surgical methods(P>0.05).ConclusionLaparoscopic hiatal hernia repair and anti-reflux procedure,including Nissen’s,Toupet’s,Dor’s fundoplication operationareall effective and with small trauma,quick recovery in the treatment of HH combined with GERD.Three kinds of operations can all achieve the effect of controlling reflux related symptoms,and Dor’s operation is worthy of clinical promotion with its shorter operation time,less bleeding in the operation,not changing the original anatomical structure and convenience for clinical operation.