Abstract:

Objective

To investigate the safety and efficacy of the multi-disciplinary team combined with enhanced recovery after surgery model （MDT-ERAS model） in the diagnosis and treatment of hiatal hernia.

Methods

This study retrospectively analyzed the clinical data of 100 patients with hiatal hernia who underwent laparoscopic hiatal hernia repair+ fundoplication at the Chengdu Fifth People's Hospital from January 2021 to January 2024.According to whether the patients were managed under the MDT-ERAS mode， they were divided into the MDT-ERAS group with 49 cases and the conventional group with 51 cases.Two groups of patients were compared in terms of general condition， intraoperative indicators， postoperative recovery， postoperative complications （including intestinal obstruction，gastrointestinal leakage， urinary retention， incision infection， abdominal infection， pulmonary infection，urinary system infection， postoperative adverse reactions， length of stay， pain score， and satisfaction score.

Results

There were no significant differences between the two groups in terms of blood loss （15.6±6.5 ml vs.15.8±6.5 ml； t=-0.194， P=0.846）， operation time （62.6±5.7 min vs.62.5±5.8 min； t=0.054， P=0.957）， and drainage tube retention rate （1/49 vs.2/51； χ²=0.000， P＞0.999）.In terms of intraoperative fluid infusion volume， the MDT-ERAS group was lower （1353.1±295.2 ml vs.1721.6±330.6 ml； t=-5.871， P＜0.001）.The time of first postoperative exhaust （17.6±4.2 h vs.25.5±3.0 h； t=-10.823， P＜0.001）， the time of first liquid diet （6.6±1.2 h vs.18.8±4.8 h； Z=-8.762， P＜0.001）， the time of first semi-liquid diet （24.9±1.3 h vs.48.8±3.5 h； Z=-8.750， P＜0.001）， the time of first getting out of bed （6.7±1.3 h vs.25.1±3.1 h； Z=-8.821，P＜0.001）， and the time of urinary catheter indwelling （1.2±0.6 d vs.1.8±0.7 d； Z=-5.239， P＜0.001） in the MDT-ERAS group were shorter than those in the conventional group.There was no statistically significant difference in the incidence of postoperative complications between the two groups.The incidence of postoperative abdominal distention （1/49 vs.8/51； χ²=4.137， P=0.042）， nausea and vomiting （2/49 vs.10/51； χ²=4.329， P=0.037） in the MDT-ERAS group was lower than those in the conventional group， and the difference was statistically significant.There was no statistically significant difference in non-infectious fever and dysphagia between the two groups.The pain score of patients in the MDT-ERAS group was lower （3.2±1.2 vs.5.2±1.4； Z=-6.175， P＜0.001）， and the average length of stay in the MDT-ERAS group was shorter （3.3±0.7 d vs.3.8±0.8 d； Z=-3.222， P=0.001） than those in the conventional group.The satisfaction score of patients in the MDT-ERAS group was higher （4.4±0.7 vs.3.6±0.8； Z=-4.384，P＜0.001）， with statistically significant difference.The average follow-up months were 20.6±7.2 in the MDT-ERAS group and 20.1±7.1 in the conventional group.One patient in each of the two groups had a recurrence.One patient in the conventional group developed dysphagia one month after surgery， and the symptoms disappeared after conservative treatment.

Conclusion

The multi-disciplinary team combined with enhanced recovery after surgery mode is safe and effective in the diagnosis and treatment of hiatal hernia.

Key words: Hernia, hiatal, Gastroesophageal reflux disease, Multi-disciplinary team, Enhanced recovery after surgery