Clinical efficacy analysis of right main operating combined with routine division of the short gastric vessels in laparoscopic Nissen fundoplication

doi:10.3877/cma.j.issn.1674-392X.2025.02.009

Abstract

Abstract:

Objective

To investigate the anatomical exposure advantages, safety, and functional prognosis of the right main working port combined with short gastric vessels (SGV) disconnection technique in laparoscopic Nissen fundoplication.

Methods

Retrospective analysis was conducted in 28 patients with gastroesophageal reflux disease (GERD) or hiatal hernia (HH) who underwent laparoscopic Nissen fundoplication at Chengdu Third People's Hospital from April 2020 to June 2023.The surgeon stood on the right side of the patient, using a five-port technique.By retracting the posterior gastric wall and vertically aligning the SGV with the splenic upper pole vessels, precise SGV disconnection was achieved.Perioperative indicators (operative time, blood loss, complications) and postoperative functional recovery (reflux control, dysphagia, GERD-HRQL questionnaire scores) were evaluated.

Results

All 28 patients successfully completed the procedure.The mean total operative time was (123.89±23.48) min,with mean SGV disconnection time of (11.14±3.51) min, and median intraoperative blood loss of 5 (5, 10)ml.No splenic injury, gastric perforation, or conversion to open surgery occurred.No postoperative dysphagia for full liquids occurred 3 day after surgery.GERD-HRQL questionnaire scores at 3 months after surgery significantly decreased compared to preoperative scores [(6.68±0.82) vs.(11.07±2.62),P<0.001].Overweight/obese patients (BMI ≥25 kg/m²) showed no significant differences in operative time or blood loss compared to non-overweight patients [(119.28±4.55) min vs.(132.2±9.11) min,P=0.226; (10.00±5.27) ml vs.(7.78±4.61) ml, P=0.256].

Conclusion

The right main working port combined with SGV disconnection optimizes anatomical exposure, reduces splenic injury risk, and achieves favorable reflux control, particularly in obese patients and complex hiatal hernia cases.However,multicenter randomized controlled trials are warranted to validate its long-term efficacy.

Key words: Gastroesophageal reflux disease, Hiatal hernia, Nissen fundoplication, Short gastric vessels, Right-sided main operating

Shihong Li, Qinwang Niu, Kehao Liu, Jiahui Yu, Peisen Guo, Yuanchuan Zhang, Dafang Zhan, Kang Hou, Pan Nie. Clinical efficacy analysis of right main operating combined with routine division of the short gastric vessels in laparoscopic Nissen fundoplication[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 167-171.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2025.02.009

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2025/V19/I02/167

Figures/Tables 4

References 21

[1]	Draaisma WA, Fegrachi S, Simmermacher RK, et al.Therapieresistente gastro-oesofageale refluxziekte: endoluminale behandeling nog onvoldoende vergeleken met de gouden standaard, laparoscopische fundoplicatie volgens Nissen[Therapy-resistant gastro-oesophageal reflux disease: endoluminal treatment not yet sufficiently compared with the gold standard, the laparoscopic Nissen fundoplication][J].Ned Tijdschr Geneeskd, 2008, 152(47): 2553-2558.
[2]	Kösek V, Wykypiel H, Weiss H, et al.Division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial[J].Surg Endosc, 2009, 23(10): 2208-2213.
[3]	刘昶, 杨凯, 纪艳超, 等.腹腔镜Roux-en-Y 胃旁路术治疗2 型糖尿病的疗效分析[J/OL].中华肥胖与代谢病电子杂志, 2015, 1(1):7-10.
[4]	皮尔地瓦斯·麦麦提玉素甫, 艾克拜尔·艾力, 买买提·依斯热依力,等.腹腔镜胃底折叠术联合胃袖状切除术治疗肥胖合并胃食管反流病临床研究[J].中国实用外科杂志, 2020, 40(4): 437-440, 443.
[5]	周太成, 江志鹏, 李英儒, 等.食管裂孔疝及胃食管反流性疾病腹腔镜下规范化七步法手术操作指南(2021 版)[J].岭南现代临床外科, 2021, 21(5): 500-506.
[6]	郑铭, 鄂一民, 陆晨, 等.胃食管反流病发生的解剖学基础及手术治疗策略[J].中华消化外科杂志, 2024, 23(11): 1465-1470.
[7]	Flum DR, Koepsell T, Heagerty P, et al.The nationwide frequency of major adverse outcomes in antireflux surgery and the role of surgeon experience, 1992-1997[J].J Am Coll Surg, 2002, 195(5): 611-618.
[8]	Huntington TR, Danielson L.Variation in fundic dimensions with respect to short gastric vessel division in laparoscopic fundoplication[J].Surg Endosc, 2001, 15(1): 76-79.
[9]	Laycock WS, Trus TL, Hunter JG.New technology for the division of short gastric vessels during laparoscopic Nissen fundoplication.A prospective randomized trial[J].Surg Endosc, 1996, 10(1): 71-73.
[10]	Schlottmann F, Nurczyk K, Patti MG.Laparoscopic Nissen Fundoplication: How I Do It?[J].J Laparoendosc Adv Surg Tech A,2020, 30(6): 639-641.
[11]	Holcomb GW 3rd, St Peter SD.Error traps and safety steps when performing a laparoscopic Nissen fundoplication[J].Semin Pediatr Surg, 2019, 28(3): 160-163.
[12]	Dallemagne B, Kohnen L, Perretta S, et al.Laparoscopic repair of paraesophageal hernia.Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate[J].Ann Surg, 2011,253(2): 291-296.
[13]	Rosado RF, Ivy ML, Farivar AS, et al.Laparoscopic revisional antireflux and hiatal hernia surgery results in a higher rate of complications and severity at 90 days than primary surgery[J].J Thorac Cardiovasc Surg, 2025, 169(4): 1155-1161.
[14]	Bonavina L.Individualizing the choice of surgical therapy for gastroesophageal reflux disease[J].Curr Opin Gastroenterol, 2025,Online ahead of print.
[15]	Nasr B, Altamimi A, Altohari B, et al.Laparoscopic Hiatal Hernia Repair: Short-Term Results From Yemen in a Resource-Limited Setting[J].Cureus, 2025, 17(1): e78010.
[16]	高颖, 杜兴, 罗颖, 等.改良Nissen 胃底折叠术治疗胃食管反流病的短期疗效分析[J].腹腔镜外科杂志, 2023, 28(1): 34-40.
[17]	杜兴, 罗颖, 高颖, 等.腹腔镜Nissen 胃底折叠联合His 角重建术治疗胃食管反流病的短期疗效[J/OL].中华疝和腹壁外科杂志(电子版), 2022, 16(5): 510-515.
[18]	Ugliono E, Rebecchi F, Franco C, et al.Long-term durability and temporal pattern of revisional surgery of laparoscopic large hiatal hernia repair[J].Updates Surg, 2025, 77(2): 419-425.
[19]	Abdelrahman T, Latif A, Chan DS, et al.Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis[J].Int J Surg, 2018, 51: 76-82.
[20]	玉素江·图荪托合提, 麦麦提艾力·麦麦提明, 艾克拜尔·艾力.肥胖在胃食管反流病发生发展中的作用机制[J].中华消化外科杂志, 2024, 23(1): 147-152.
[21]	Nadeem F, Singh A, Karim M, et al.The Impact of Obesity on Reflux Recurrence Following Laparoscopic Anti-reflux Surgery: An Evidence-Based Systematic Review and Meta-Analysis[J].Cureus,2024, 16(3): e56981.

组别	例数	手术时间(min)	术中出血量(ml)
超重及肥胖组	10	132.20±9.11	10.00±5.27
非超重组	18	119.28±4.55	7.78±4.61
t 值		1.422	1.162
P值		0.226	0.256

组别	例数	手术时间(min)	术中出血量(ml)
超重及肥胖组	10	132.20±9.11	10.00±5.27
非超重组	18	119.28±4.55	7.78±4.61
t 值		1.422	1.162
P值		0.226	0.256

Please choose a citation manager

Content to export