Analysis Of Short-term Clinical Effect Of Laparoscopic Nissen Fundoplication Combined With Tension-free Repair Of EHH In The Treatment Of GERD Complicated With EHH

Objective: To investigate the short-term clinical efficacy of the operation of laparoscopic Nissen fundoplication(LNF)combined with tension-free repair of esophageal hiatal hernia(EHH)in the treatment of gastroesophageal reflux disease(GERD)combined with EHH.Methods: The clinical data of 30 patients receiving LNF combined with tensionfree repair of EHH in our hospital from June 2017 to June 2020 were collected.All patients were followed up at least 6 months.The difference of symptom scores,the results of gastroscopy,acid monitoring and esophageal dynamics monitoring between preoperative and postoperative were compared.The incidence of postoperative diarrhea and abdominal distension was observed,and the degree of operation-related dysphagia was quantitatively evaluated by VAS.Results: All the 30 enrolled patients with GERD complicated with EHH were successfully underwent laparoscopic anti-reflux surgery.The GERD-Q scores at 1,3and 6 months at postoperative were improved compared with those before surgery.Similarly,the Demeester score,lower esophageal sphincter pressure,and distal contractile integral were significantly improved 6 months after surgery(P <0.05).However,there was no significant improvement in the upper esophageal sphincter pressure after operation(P >0.05).The endoscopic reexamination in 6 months after the operation indicated different degrees of remission of esophagitis,and the overall endoscopic remission rate was 73.3%.All the patients were assessed to Ⅲ ～ Ⅳ degree in the assessment of gastroesophageal flap valve preoperatively,and the reexamination in 6 months after surgery showed all were transformed into normal Ⅰ ～ Ⅱ level.All patients took proton pump inhibitor for acid suppressant therapy for a long time before surgery,and proton pump inhibitor was stopped in 73.3% of patients in 6 months after surgery.In terms of complications,diarrhea and abdominal distension occurred in 1 and3 patients,within 1 month postoperatively respectively,but all of them improved significantly at the follow-up to 6 months.During the follow-up,no serious complications such as recurrence,mesh related complications(such as mesh ectopic,erosion,etc.),upper gastrointestinal fistula occurred.The quantitative assessment of dysphagia showed that 6 patients and 1 patient had a VAS of 5-8 at 1 month and 3months postoperatively,respectively.The remaining patients had no or only mild dysphagia(VAS≤4).For both liquid and solid foods,the VAS decreased with the prolonging of follow-up time.All dysphagia symptoms were mild and no surgical intervention such as endoscopic dilation or reoperation was required.Conclusion: The operation of laparoscopic Nissen fundoplication combined with tension-free repair of EHH has a significant short-term clinical effect on GERD combined with EHH.There are few postoperative complications,and most of the symptoms are mild.The operation is of high safety,which is worthy of clinical promotion.