Experience of laparoscopic hiatal hernia repair and fundoplication in municipal hospital

doi:10.3877/cma.j.issn.1674-392X.2022.01.010

Abstract

Abstract:

Objective

To explore the technical points and clinical effectiveness of laparoscopic hiatal hernia repair and fundoplication in municipal hospital.

Methods

We retrospectively analyzed clinical data of 31 patients who underwent laparoscopic hiatal hernia repair and fundoplication in Xianyang Central Hospital between March 2016 and March 2019. Different types of fundoplication were carried out including Dor fundoplication, Toupet fundoplication and Nissen fundoplication. The operative time, intraoperative blood loss and hospital stay of patients in each fundoplication group were observed and recorded. The rates of complications and recurrence were followed up for 3 to 36 months.

Results

All 31 patients completed laparoscopic hiatal hernia repair and fundoplication. There were 4 cases of Dor fundoplication, 3 cases of Toupe fundoplication and 24 cases of Nissen fundoplication. The operative time of the Dor fundoplication was (60±4.5) minutes, the Toupet fundoplication was (68±6.3) minutes, the Nissen fundoplication was (70±9.2) minutes. The intraoperative blood loss was (21±4.8) ml for Dor fundoplication, (24±5.4) ml for Toupet fundoplication, (30±9.1) ml for Nissen fundoplication. The postoperative hospital stay was (7±2.1) days for Dor fundoplication, (8±2.8) days for Toupet fundoplication, (9±2.4) days for Nissen fundoplication. Clinical symptoms of all 31 patients had been alleviated effectively after operation. 4 patients had developed postoperative complications of dysphagia, one of them was relieved after removal of fundoplication by a second operation due to unsatisfactory conservative symptomatic treatment, the other 3 patients were relieved after symptomatic treatment. In 31 patients, 1 patient lost to follow up. The median follow-up time was 28 months (range, 3-36 months). Gastroscopy and upper gastrointestinal radiography showed no recurrence or other complications.

Conclusion

Laparoscopic repair of esophageal hiatal hernia and fundoplication is safe, effective, minimally invasive and worthy of clinical promotion.

Key words: Esophageal hiatal hernia, Gastroesophageal reflux disease, Laparoscope, Fundoplication

Ying Li, Abudureyimu Kelimu·, Lei Du, Fuping Ma. Experience of laparoscopic hiatal hernia repair and fundoplication in municipal hospital[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(01): 44-48.

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Figures/Tables 2

References 16

[1]	Testoni PA, Mazzoleni G, Testoni SG. Transoral incisionless fundoplication for gastro-esophageal reflux disease: techniques and outcomes[J]. World J Gastrointest Pharmacol Ther, 2016, 7(2): 179-189.
[2]	彭延春，刘祥尧，赵司卫. 腹腔镜食管裂孔疝修补术联合不同抗反流术式治疗食管裂孔疝合并胃食管反流病的临床比较力[J]. 中国内镜杂志, 2019, 25(4): 11-18.
[3]	Soresi AL. Diaphragmatic hernia: its unsuspected frequency: its diagnosis: technic for radical cure[J]. Ann Surg, 1919, 69(3): 254-270.
[4]	陈双，周太成，马宁. 食管裂孔疝修补力求结构与功能的统一[J/OL]. 中华胃食管反流病电子杂志, 2019, 6(2): 49-54.
[5]	Chandrasoma P. How the pathologist can aid in asseeement of gastroesophageal reflux disease[J]. Curr Opin Gastroenterol, 2018, 34(4): 233-243.
[6]	Navarro-Rodriguez T, Hashimoto CL, Carrilho FJ, et al. Reduction of abdominal pressure in petients with ascites reduces gastroesophageal reflux[J]. Dis Esophagus, 2003, 16(2): 77-82.
[7]	杜智，张成，克力木. 滑动型食管裂孔疝长度与胃食管反流病关系的研究[J]. 临床外科杂志, 2017, 25(1): 75-77.
[8]	苏福增，张成，克力木, 等. 腹腔镜Nissen、Toupet和Dor胃底折叠术治疗食管裂孔疝并胃食管反流病的疗效分析[J]. 中华胃肠外科杂志, 2016, 19(9): 1014-1020.
[9]	蒋菁梅，于磊，刘晶, 等. 食管测压指导Nissen胃底折叠术31例[J]. 世界华人消化杂志, 2010, 18(9): 947-949.
[10]	张严，李金东，王广鑫, 等. 腹腔镜Toupet胃底折叠治疗食管裂孔疝合并胃食管反流病的临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(4): 309-311.
[11]	梁明强，朱勇，郑炜, 等. 腹腔镜下治疗食管裂孔疝55例报告[J]. 中国微创外科杂志, 2014, 18(9): 947-949.
[12]	张振松，贺跃，张学军, 等. 腹腔镜食管裂孔疝修补联合胃底折叠术54例临床疗效分析[J/OL]. 中华胃食管反流病电子杂志, 2017, 4(2): 52-55.
[13]	王杰，罗浩，王剑, 等. 腹腔镜下Nissen胃底折叠术联合食管裂孔疝修补术的疗效及预后[J]. 中国现代普通外科进展, 2017, 20(1): 58-59, 62.
[14]	蔡旺，秦鸣放，邹富胜, 等. 腹腔镜Nissen胃底折叠术与腹腔镜前180°部分胃底折叠术后5年临床效果的比较[J]. 世界华人消化杂志, 2012, 20(14): 1234-1237.
[15]	张成，克力木，王忠镐. 食管裂孔疝胃底折叠方式选择及评价[J]. 腹腔镜外科杂志, 2016, 21(2): 88-91.
[16]	Memon MA, Subramanya MS, Hossain MB, et al. Laparoscopic anterior versus posterior fundoplication for gastroesophageal reflux disease: a meta-analysis and systematic review[J]. World J Surg, 2015, 39(4): 981-996.

组别	例数	中位年龄(岁)	性别(例)		手术时间(min, ±s)	术中出血量(ml, ±s)	术后出院时间(d, ±s)	术后吞咽困难[例(%)]
组别	例数	中位年龄(岁)	男性	女性	手术时间(min, ±s)	术中出血量(ml, ±s)	术后出院时间(d, ±s)	术后吞咽困难[例(%)]
Dor术式	4	63	2	2	60±4.5	21±4.8	7±2.1	0(0)
Toupet术式	3	59	2	1	68±6.3	24±5.4	8±2.8	1(33.3)
Nissen术式	24	64	20	4	70±9.2	30±9.1	9±2.4	3(12.5)

组别	例数	中位年龄(岁)	性别(例)		手术时间(min, ±s)	术中出血量(ml, ±s)	术后出院时间(d, ±s)	术后吞咽困难[例(%)]
组别	例数	中位年龄(岁)	男性	女性	手术时间(min, ±s)	术中出血量(ml, ±s)	术后出院时间(d, ±s)	术后吞咽困难[例(%)]
Dor术式	4	63	2	2	60±4.5	21±4.8	7±2.1	0(0)
Toupet术式	3	59	2	1	68±6.3	24±5.4	8±2.8	1(33.3)
Nissen术式	24	64	20	4	70±9.2	30±9.1	9±2.4	3(12.5)

组别	例数	Ⅰ型疝	Ⅱ型疝	Ⅲ型疝	Ⅳ型疝
Dor术式	4	3(75)	1(25)	0(0)	0(0)
Toupet术式	3	2(66.67)	1(33.33)	0(0)	0(0)
Nissen术式	24	19(79.17)	3(12.5)	2(8.33)	0(0)

组别	例数	Ⅰ型疝	Ⅱ型疝	Ⅲ型疝	Ⅳ型疝
Dor术式	4	3(75)	1(25)	0(0)	0(0)
Toupet术式	3	2(66.67)	1(33.33)	0(0)	0(0)
Nissen术式	24	19(79.17)	3(12.5)	2(8.33)	0(0)

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