To observe and analyze the clinical efficacy of laparoscopic hiatal hernia repair combined with Dor fundoplication in the treatment of hiatal hernia and the predictive significance of esophageal manometry and pH monitoring on long-term effectiveness.

The clinical data of 120 patients with hiatal hernia admitted to the Second Affiliated Hospital of Hebei Northern University from January 2018 to January 2020 were retrospectively analyzed, of which 64 patients underwent laparoscopic hiatal hernia repair combined with Nissen fundoplication (Nissen group), 56 cases underwent laparoscopic hiatal hernia repair combined with Dor fundoplication (Dor group). The patients were followed up for 1 year after the operation, and the operation conditions, hospitalization time, postoperative complications, changes in esophageal manometry and pH detection, and Gerd Q and DeMeester scores were compared between the two groups.

The operation course and intraoperative blood loss in the Nissen group were significantly higher than those in the Dor group (P<0.05), and there was no significant difference in the total hospitalization time between the two groups (P>0.05). There was no significant difference in the incidence of total postoperative complications between the two groups (P>0.05); the esophageal reflux and DeMeester scores of the two groups at 1 year after operation were significantly improved compared with those before operation. The Nissen group was better than the Dor group in reducing the number of regurgitations, the length of regurgitation and the longest regurgitation time (P<0.05). There was no significant difference in the reflux time, acid reflux time percentage and DeMeester score between the two groups (P>0.05); the lower esophageal sphincter pressure, resting breath average value and esophageal residual pressure in the two groups after operation were significantly increased compared with those before operation (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). The esophageal relaxation rate, invalid swallowing and Gerd Q score of the two groups after operation were also significantly lower than those before operation, but there was no significant difference between the two groups (P>0.05).

Laparoscopic hernia repair combined with Nissen or Dor fundoplication has an obvious effect in the treatment of hiatal hernia, and the appropriate surgical method should be selected according to the patient's own situation.