Abstract:

Objective

The feasibility of laparoscopic combined gastroscopy for Heller muscle incision， hiatal hernia repair and Dor fundoplication was discussed， and the surgical techniques and clinical efficacy of this combined operation were defined， so as to provide a standardized scheme for clinical functional repair and anatomical reconstruction.

Methods

A retrospective analysis was conducted on clinical data from 19 patients with achalasia and hiatal hernia treated in the Department of Minimally Invasive， Hernia and Abdominal Wall Surgery at Xinjiang Uygur Autonomous Region People's Hospital between June 2014 and October 2024. All patients underwent laparoscopic Heller myotomy combined with hiatal hernia repair and Dor fundoplication assisted by endoscopy. Operative time， intraoperative blood loss， complications， and recurrence were analyzed， with follow-up observations.

Results

All 19 patients were definitively diagnosed with achalasia via gastroscopy， upper gastrointestinal contrast， and high-resolution manometry. According to the Chicago Classification， 2 cases were typeI， 15 cases were type Ⅱ， and 2 cases were type Ⅲ. The surgeries were successful， with 1 case converted to thoracotomy. The median operative time was 82 （57-185） minutes， intraoperative blood loss was 20 （10-50） ml， and no gastroesophageal fistula occurred.The median postoperative hospital stay was 3.0 （2-6） days. During a median follow-up of 37 months （5-122 months）， 2 cases experienced transient dysphagia， but no recurrence or severe gastroesophageal reflux was observed.

Conclusion

Laparoscopic Heller myotomy combined with hiatal hernia repair and Dor fundoplication is safe and effective. However， larger sample sizes are required to validate long-term efficacy.

Key words: Achalasia, Hernia, Hiatal, Fundoplication, Clinical efficacy