| Objective:To explore the clinical efficiency of treatment for hiatal hernia through transabdominal esophageal hiatus repair and Dor fundoplication.Methods:34 patients with hiatal hernia underwent transabdominal esophageal hiatus repair and Dor fundoplication in Department of thoracic surgery of Tianjin Chest Hospital, Mar 2008 to Jan 2011. There were 12 male patients and 22 female patients. The age was 55 to 81 years old (with a mean of 68.4 years old) and 16 patients (47.3%) over 70 years. Sliding hiatus hernia in 15 cases, paraesophageal hernia in 6 case, mixed type hernia in 13 cases.9 patients were huge hiatus hernia, one case was recurrence after laparoscopic hernia repair and another 4 cases occurred intrathoracic gastric volvulus. History from 2 months to 30 years,18 cases with heartburn symptoms,9 patients with abdominal discomfort or fullness feeling,6 cases with retrosternal discomfort (heart disease were excluded),2 patients with tarry stools,5 cases with mild to moderate anemia,1 case can not eat more than one month, completely depend on intravenous nutrition to sustain life.10 cases with cough and asthma symptoms in all patients. Pulmonary function tests suggest there are varying degrees of pulmonary dysfunction. Six cases whose lung function FEV1 ranging from 0.73-1.03L did not have the basic conditions for thoracic surgery.The Patients evaluated before and after operation, including clinical symptom score, gastroscopy, upper gastrointestinal radiograpHy,24-hour esophageal pH and esophageal manometry. We analysed the matched indexes and observed the effectiveness of hital hernia with Dor fundoplication.Methods:All the patients underwent the procedure successfully.The totle time of the procedure ranged from 50 to 160 min,with a mean of 90 min. Volume of blood loss during the operation ranged from 30 to 250 ml,with a mean of 100 ml. The average hospital stay after an operation was 7.8 days(range 6-15days). Gastrointestinal decompression for patients 1 to 3 days after operation.The mean follow-up time for all patients was 9.3 months(range 3-24 months). After 3 months follow-up, the symptoms of 32 patients disappeared completely,1 patients appeared mild dysphagia and symptoms disappeared 3 months later, and 1 patients changed little because of severe depression, but the results of 24-hours esophageal pH and esophageal motility and upper gastrointestinal contrast were all normal after 3 months of surgery. There were statistical differences between preoperative and postoperative at 3 months in the results of 24- hour esophageal pH and manometry (P<0.05).The anatomic of the gastroesophageal were recovered normal by upper gastrointestinal contrast after 3 months of surgery. There was no evidence of hiatus hernia recurrence. PPI medication was not necessary in all patients at last follow up. The satisfaction rate was 94.1%.The sensitivity of the gastroscopy is 76.5% and that of upper gastrointestinal radiography is 67.6% in pre-operative diagnosis.The accuracy of diagnosis would raise, with the assistance of 24- hour esophageal pH and manometry.Conclusions:The main reason for hiatal hernia in our department(85.2%) is the gastroesophageal reflux symptoms.Gastroscopy have highers ensitivity than Upper gastrointestinal radiography. The diagnose will be more accurate if combined with gastroscopy, radiography,24-hour esophageal pH and manometry (91.2%). We should be careful with the patients who have depression or anxiety symptoms produced by serious reflux, it may affect efficacy for such patients. Dor fundoplication minimizes trauma and blood loss, shortens the operatings and simple operation, few complications and high satisfaction. The incidence of postoperative dysphagia was low.Patients do not need to take anti-reflux drugs and without symptoms of gastroesophageal reflux. As the number of cases was small and the time since operation was short, long-term effect needs further follow-up observation. |
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