To investigate the feasibility of preserving the hepatic branch of the vagus nerve during laparoscopic hiatal hernia repair combined with fundoplication and its effect on postoperative gallbladder function.

This retrospective cohort study included 73 patients with gastroesophageal reflux disease complicated by hiatal hernia who underwent laparoscopic hiatal hernia repair in the Department of General Surgery, Shenzhen Hospital, Southern Medical University, from January 2019 to December 2023. Seventeen patients who underwent other concomitant procedures and two patients with recurrent hernia or type IV hernia were excluded. The remaining 54 patients were divided into the hepatic branch of the vagus nerve preservation group (n=17) and the hepatic branch of the vagus nerve resection group (n=37) according to whether the hepatic branch of the vagus nerve was preserved during surgery. Operative time, intraoperative blood loss, length of hospital stay, postoperative complications, and other indicators were compared between the two groups. All patients underwent routine outpatient follow-up at 1, 6, 12, and 36 months after surgery, and abdominal ultrasonography or computed tomography (CT) was performed to monitor gallbladder status. The incidence of gallstones was recorded.

There were no statistically significant differences between the hepatic branch of the vagus nerve preservation group and the resection group in operative time, intraoperative blood loss, length of hospital stay, or complications (P>0.05). In the hepatic branch of the vagus nerve resection group, two cases of asymptomatic gallstones were detected at the 6-month postoperative follow-up. With prolonged follow-up, the number of patients with gallstones increased. At the 3-year follow-up, gallstones were detected in nine patients (24.30%). No imaging evidence of gallstones or other gallbladder lesions was observed in the remaining patients. At 3 years after surgery, the incidence of gallstones in the hepatic branch of the vagus nerve resection group was significantly higher than that in the hepatic branch of the vagus nerve preservation group (24.30% vs. 0.0%), and the difference was statistically significant (P<0.05).

Preserving the hepatic branch of the vagus nerve during laparoscopic hiatal hernia repair combined with fundoplication is feasible. In the short term, it may reduce the impact on gastrointestinal function and facilitate postoperative recovery. In the long term, it may help reduce the formation of gallstones; however, whether this effect is attributable to preservation of the hepatic branch of the vagus nerve requires further investigation.