Clinical application of the 3+2+1 anatomical dissection and suturing strategy in totally robotic hiatal hernia repair combined with fundoplication

doi:10.3877/cma.j.issn.1674-392X.2026.03.005

Abstract

Abstract:

Objective

To evaluate the clinical value and significance of the "3+2+1" anatomical dissection and suturing strategy in totally robotic hiatal hernia repair combined with fundoplication.

Methods

This is a single-center retrospective observational study. A total of 52 patients with gastroesophageal reflux disease (GERD) who underwent totally robotic hiatal hernia repair combined with fundoplication at the Department of General SurgeryⅡ, Yan'an Hospital Affiliated to Kunming Medical University, from January to December 2025 were enrolled. All procedures were performed using the "3+2+1" anatomical dissection and suturing strategy. Perioperative indicators, postoperative symptom improvement, and patient satisfaction were analyzed.

Results

All surgeries were completed successfully without conversion to open surgery or complications, with 100% patient satisfaction. The mean robotic operating time was (82.03±32.91) minutes, intraoperative blood loss was 5 (5,5) ml, and postoperative hospital stay was (3.80±1.70) days. Gastroesophageal reflux disease questionnaire and gastroesophageal reflux disease-health related quality of life scores at 1, 3, 6, and 12 months postoperatively were significantly lower than preoperative values (all P<0.001).

Conclusion

Totally robotic hiatal hernia repair combined with fundoplication utilizing the "3+2+1" anatomical dissection and suturing strategy is safe and reliable, effectively alleviating reflux symptoms in patients with GERD, promoting rapid recovery, and achieving high patient satisfaction.

Key words: Gastroesophageal reflux disease, Fundoplication, Robotic surgery, Hernia, hiatal

Dingwei Lu, Hongrui Guo, Di Liu, Xianlong Mao, Honglin Yi, Rujuan Wang, Chunli Zou, Peng Li. Clinical application of the 3+2+1 anatomical dissection and suturing strategy in totally robotic hiatal hernia repair combined with fundoplication[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(03): 265-271.

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Figures/Tables 11

References 20

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项目	例(%)
性别
男性	34(65.4)
女性	18(34.6)
年龄
<40岁	8(15.4)
40~59岁	19(36.5)
60~79岁	20(38.5)
≥80岁	5(9.6)
体重指数
偏瘦(<18.5 kg/m²)	3(5.8)
正常(18.5~23.9 kg/m²)	24(46.2)
超重(24.0~27.9 kg/m²)	18(34.6)
肥胖(≥28.0 kg/m²)	7(13.5)
胃食管阀瓣分级
Ⅱ级	3(5.8)
Ⅲ级	13(25.0)
Ⅳ级	36(69.2)
洛杉矶分级
A级	16(30.8)
B级	11(21.2)
C级	3(5.8)
D级	3(5.8)
无	19(36.5)
食管胃连接部分型
Ⅰ型	3(5.8)
Ⅱ型	33(63.5)
Ⅲ型	16(30.8)
复发疝
是	3(5.8)
否	49(94.2)

项目	例(%)
性别
男性	34(65.4)
女性	18(34.6)
年龄
<40岁	8(15.4)
40~59岁	19(36.5)
60~79岁	20(38.5)
≥80岁	5(9.6)
体重指数
偏瘦(<18.5 kg/m²)	3(5.8)
正常(18.5~23.9 kg/m²)	24(46.2)
超重(24.0~27.9 kg/m²)	18(34.6)
肥胖(≥28.0 kg/m²)	7(13.5)
胃食管阀瓣分级
Ⅱ级	3(5.8)
Ⅲ级	13(25.0)
Ⅳ级	36(69.2)
洛杉矶分级
A级	16(30.8)
B级	11(21.2)
C级	3(5.8)
D级	3(5.8)
无	19(36.5)
食管胃连接部分型
Ⅰ型	3(5.8)
Ⅱ型	33(63.5)
Ⅲ型	16(30.8)
复发疝
是	3(5.8)
否	49(94.2)

观察时间	术前	术后1个月	术后3个月	术后6个月	术后12个月
GerdQ评分	10.0(9.0,11.0)	3.0(1.0,4.0)	2.0(1.0,2.0)	0.0(0.0,1.0)	0.0(0.0,1.0)
Z值^a	-	-6.336	-6.378	-5.914	-3.362
P值^a	-	<0.001	<0.001	<0.001	<0.001
GERD-HRQL评分	41.0(36.0,44.0)	7.0(6.0,12.0)	5.0(3.0,8.0)	3.0(2.0,6.0)	1.0(0.0,4.0)
Z值^a	-	-6.292	-6.287	-5.790	-3.315
P值^a	-	<0.001	<0.001	<0.001	<0.001

观察时间	术前	术后1个月	术后3个月	术后6个月	术后12个月
GerdQ评分	10.0(9.0,11.0)	3.0(1.0,4.0)	2.0(1.0,2.0)	0.0(0.0,1.0)	0.0(0.0,1.0)
Z值^a	-	-6.336	-6.378	-5.914	-3.362
P值^a	-	<0.001	<0.001	<0.001	<0.001
GERD-HRQL评分	41.0(36.0,44.0)	7.0(6.0,12.0)	5.0(3.0,8.0)	3.0(2.0,6.0)	1.0(0.0,4.0)
Z值^a	-	-6.292	-6.287	-5.790	-3.315
P值^a	-	<0.001	<0.001	<0.001	<0.001

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