Abstract:

Objective

To investigate the feasibility, clinical efficacy and safety of laparoscopic hiatal hernia repair with fundoplication for hiatal hernia (HH) with gastroesophageal reflux disease(GERD) patients.

Methods

A total of 40 patients with HH and GERD who underwent laparoscopic hiatal hernia repair and fundoplication at Drum Tower Hospital in Nanjing from January to December 2023 were selected. The clinical basic information, surgical related indicators, postoperative complications, the reflux situation and changes in esophageal pressure before and after surgery were analyzed.

Results

All 40 cases of laparoscopic HH repair with fundoplication were successfully completed. The average surgery time was (145.83±33.77) minutes, the average intraoperative blood loss was (33.67±23.36) ml, the average postoperative hospital stay was (4.80±0.98) days, and the average postoperative time to consume fluids was(1.82±0.64) days. There were no serious complications, deaths, or recurrence cases during follow-up. At 6 months after surgery, number of refluxes, number of long reflux, reflux time, percentage of acid reflux time,DeMeester score, and Gerd Q score were significantly improved compared to preoperative levels (P＜0.05). The resting pressure of the lower esophageal sphincter and residual pressure of the esophagus increased significantly compared to preoperative levels (P ＜ 0.05), while the esophageal relaxation rate and ineffective swallowing ratio also decreased significantly compared to preoperative levels (P＜0.05).

Conclusion

Laparoscopic HH repair with fundoplication is a safe and feasible surgical method for treating HH with GERD. It can effectively improve the patient's esophageal function, reduce the patient's reflux symptoms, and has clear clinical efficacy.

Key words: Hernia, hiatal, Gastroesophageal reflux disease(GERD), Laparoscopic surgery, Fundoplication, Clinical analysis