| Objective:Evaluation of the clinical efficiency of Da Vince robot assisted surgery and laparoscopicsurgery in the esophageal hiatal hernia.Method:Retroactive cohort study was employed to for this study.The Clinical data of 50 patients who received minimally invasive hiatal hernia repair in the first affiliated hospital of NanChang university from September 2017 to September 2019 were collected.In which twenty patients receiving laparoscopic hiatal hernia repair,and thirty patients undergoing Da Vinci robot assisted hiatal hernia repair were respectivelv allocated into the laparoscopy surgery group(CLS group)and Da Vinci robot assisted surgery groups(RAS group).Operation : All patients underwent transabdominal approach surgery.Observation indicators :(1)Operation time,intraoperative blood loss,intraoperative complications,postoperative hospitalization days,indwelling drainage tube days,perioperative complications and so on;(2)Symptoms follow-up and thesituation recurrence..Telephone follow-up was conducted.To determine the postoperative remission of symptoms and whether there is recurrence in those symptomatic patiens.They were followed up until March 2020.Result:(1)Perioperative date of the two group were compared.There have difference in mean operating time and intraoperative estimate blood loss(the p value was less than 0.05),the mean operating time in the CLS group was 129.10 ± 25.40 min,in the RAS group was 113.90±27.50 min.There have no difference in mean postoperative hospital stay,and days of indwelling drainage tube in both group,mean postoperative hospital stay,and days of indwelling drainage tube in CLS group was 7.40 ± 1.20 days and 3.80 ± 0.90 days.while,the mean postoperative hospital stay and time of indwelling drainage tube in RAS group was 7.60 ± 1.70 days and 3.50 ± 0.90.There were no difference in both group.In both group there were no patients transfer to open surgery.There was no difference in postoperative complications in both group,there have three patients developed pulmonary infected in the RAS group.Howere the CLS beside two patients have pulmonary infected there also have three patients the symptoms had no obvious relief.(2)The result of follow-up : A total of fifty five patients in both groups were followed up after surgery.The follow-up time was range six months from thirty months,and the median follow-up time was eighteen months.The remission of symptoms and postoperative recurrence were compared between the two groups,there was no difference(the p value is gather than 0.05).In the RAS group,eight patients presented no complains or easily manageable,two patient presented pyrosis,three patients presented regurgitation,and one patient presented chronic diarrhea,two patients presented sligh dysphagia.while in the CLS group there have nine patients presented no complain or easily manageable,one patient presented pyrosis,five patients presented regurgitation,and one patient presented chronic diarrhea,but in the CLS group there also have two patients presented sligh dysphagia.In the symptomatic patients we take further examination,in the RAS group there have two patients radiological recurrence,and in the CLS group there patients radiological recurrence.Conclusions:(1)Both Da Vinci robot-assisted laparoscopic and laparoscopic are effective surgery trentments for sympatomatic hiatal hernia;(2)Compared with conventional laparoscopic surgery,robot-assisted laparoscopic has the advantages of shorter operation time and less intraoperative blood loss for large hiatal hernia and recurrent hiatal hernia... |
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