The Observation Of Long-term Effect For Hiatal Hernia Through Transabdominal Esophageal Hiatus Repair And Dor Fundoplication

Objective:To explore the long-term effect and the value of treatment for hiatal hernia through transabdominal esophageal hiatus repair and Dor fundoplication.Methods:From October2007to September2011,41cases of hiatal hernia were enrolled to undertake transabdominal esophageal hiatus repair and Dor fundoplication in Chest Hospital of Tianjin City. There were eight male patients and thirty-three female patients. The age was different from thirty-four to eighty-one years old(mean age sixty-seven years old),and2cases among thirty to fifty years old,19cases among fifty to seventy years old,20cases above seventy years old. Patients have reflux of acid in different level before going to the hospita1.28cases mainly showed the reflux of acid and heartburn,8cases showed epigastric pain.5cases showed nausea and vomiting. History was from3months to30years. The patients were assessed through operation time, intraoperative blood loss,postoperative length of hospital stay, postoperative symptoms, gastroscopy before and after operation, esophageal manometry,24-hour esophageal pH, upper gastrointestinal radiography,quality of life, complication in preoperative time short-term and long-term period of postoperation. Through matching t test method of pairing indicators, we observe the long-term effect for Hiatal Hernia through transabdominal esophageal hiatus repair and Dor fundoplication.Result:41patients were operated successfully. The time of the procedure ranged from60minutes to180minutes with a mean of85minutes. Volume of blood loss ranged from20to80ml,with a mean of35ml. The average hospital stay after an operation was12days(range7-30days). Postoperative symptoms such as heartburn acid reflux were alleviated significantly, no perioperative deaths.41cases were followed up, the mean follow-up period was3.4years(range1-5years), no cases postoperatively recurrent. The rate of surgical satisfaction was95.12percent.1case suffered the infection of the wound, and recovered by dressing change. Dysphagia to varying extent occurred in4cases in short term. Three of them could endured and the rest one improved by saccule dilating.2cases still had the symptom of dysphagia when eating solid food in long-term follow-up,but both of them could endured that. The results of24-hour esophageal pH and manometry showed that it increased lower esophageal sphincter pressure and established esophageal anti-reflux barrier to inhibit acid reflux through the operation.Patients with esophagitis had different degrees of esophageal inflammation,and it recovered to normal one year after the surgery according to the gastroscope examination. Compared quality of life,24-hour esophageal pH and manometry,the result showed that there was statistically significant difference (P<0.05) between long-term postoperation and preoperation, there was no statistically significant difference (P>0.05) between long-term postoperation and short-term postoperation.Conclusions:With the application of the imaging and endoscopic examination technology and the raising level of understanding of disease, hiatal hernia which is common in Europe and America increases in our country year by year. Laparoscopic technology developed rapidly in our country, several3A grade hospital can do this kind of surgery, but it is still in the exploratory stage and exists certain gaps from abroad, with the restriction of hardware conditions, part of the hospitals do not have laparoscopic related technologies and equipment. Therefore, it is a kind of more practical choice through transabdominal esophageal hiatus repair and Dor fundoplication and it also have the advantage of less bleeding,little impact on heart and lung function in patients, exact curative effect, low cost,so it has clinical value. Due to the limited clinical data, follow-up of the postoperatively curative effect is only five years, more long-dated curative effect still needs to be followed-up.