To compare the esophageal dynamic changes before and after laparoscopic Nissen fundoplication (LNF) in patients with gastroesophageal reflux disease (GERD) by high resolution manometry (HRM) and to explore the anti-reflux mechanism of the procedure.

A total of 73 consecutive hospitalized patients with GERD were included. A series of preoperative evaluations including HRM were performed within 1 weeks before LNF. After the GERD symptoms were significantly relieved and dysphagia and other complications disappeared, the HRM was rechecked. The 9 esophageal motility parameters of the HRM before and after operation were compared and analyzed, and further analysis was made on whether or not there were hiatus hernia before the operation.

The average length of esophagus was prolonged by (0.43±1.72) cm after operation, and the length of intra-abdominal and lower esophageal sphincter was prolonged by (1.20±0.94) cm. Postoperative resting pressure of the lower esophageal sphincter increased by an average of (5.99±7.79) mmHg and the integrated relaxation pressure increased by (3.41±5.43) mmHg. The distal contractile integral increased by an average of (157.26±596.01) mmHg?s?cm, the distal latency increased by an average of (0.93±2.30) s, the above 6 motility parameters compared with preoperative had significant difference (P=0.04, <0.01, <0.01, <0.01, 0.03, <0.01). There were no significant differences in the length of the lower esophageal sphincter, the pressure of the upper esophageal sphincter and the contractile front velocity after operation (P=0.83, 0.43, 0.73). The length of the esophagus, the length of the lower esophageal sphincter, and the distal contractile integral were significantly improved in the patients with hiatal hernia comparing with those without hiatal hernia (P<0.01, <0.01, <0.01).

The effective anti-reflux effect is mainly achieved by prolonging the length of the intraperitoneal esophageal, enhancing the lower esophageal sphincter pressure and enhancing the esophageal clearance function by LNF. Patients with esophageal hiatal hernia had better esophageal motility improvement than those without esophageal hiatal hernia.

To evaluate the advantages and disadvantages of nano-bionic and anti-adhesive compound hernia patch to repair the collagen synthesis function of the abdominal wall hernia.

90 adult male SD rats were randomly divided into 3 groups: NT group (nano-bionic and anti-adhesive compound hernia patch), PP group (polypropylene patch) and PE group (polyester patch), building a model of the abdominal wall hernia. The patch approximately 3 cm×2 cm in size was sutured to theabdominal wall defect. After the postoperative observation of rats, 10 rats were executed at 4, 6 and 8 weeks after surgery, respectively, and the formation of collagen tissue in the abdominal wall was observed. Shearing patch and its surrounding tissues for histologic observation and analysis of collagen protein expression, and Western bolt analysis of type I collagen and typeⅢ collagen expressionin abdominal wall repair area.

The postoperative general conditions of rats were good, and there were no adverse events such as death. In the area of abdominal wall surgery, the NT group had soft touch and less foreign body sensation, and no obvious abdominal organ protruding, and the fibrous tissue was growingwell. The feeling of the PP group was more rigid, and there were a large number of subcutaneous neovascularization. The abdominal wall repair area of the PE group was stiff, and the growth of the fibrous tissue was better. Histological observation: at each time point, the repair effect of NT group was better than that of PP group and PE group. NT group had more type I collagen expression, and less typeⅢ collagen expression. It had more reasonableratio of typeⅠ/Ⅲ collagen, more mature and stable fiber structure. Tissue protein: TypeⅠ collagen gradually increased over time in each group; At each time points, the NT group was obviously higher than that of PP group and PE group; At 6 weeks and 8 weeks after surgery, the ratio of typeⅠ/Ⅲ collagen in the NT group was about 4∶1, significantly increasingcompared with 4 weeks after the operation.

In the process of routine tension-free repair of abdominal wall defect, the nano bionic, antiblocking compound hernia patch has earlier mature and stable fiber structurethan polypropylene patch and polyester patch, providing a more solid repair effect. It is applicable to the conventional abdominal wall hernia repair, especially in large abdominal wall defect caused by abdominal wall hernia.

To analyze a modified method of laparoscopic treatment for pediatric indirect inguinal hernia, single-site laparoscopic percutaneous extraperitoneal closure of the internal ring using an ordinary taper needle, to evaluate its safety and efficacy.

During August 2016 and June 2017, 400 children with indirect inguinal hernia were operatedlaparoscopicallyin a same teamof surgeons. They were divided into two groups according to different operation procedureperformed. 208 cases were enrolled in the study group and all these patients had been underwent high ligation surgery with a modified single-site laparoscopic technique: mainly performed by extracorporeal suturing only with an ordinary taper needle (1/2 Arc 11x34). While the control group was consisted of 192 cases, and they were sutured by taper needle along withEndoclose needle. The clinical data were collected and analyzed retrospectively.

All surgeries were successful without serious complications. In terms of hospitalization expenses and Auxiliary forceps utilization, the differences were statistically significant (P<0.05). While on the issues of operative time, length of hospital stay, intraoperative vessels injury, postoperative complications and as well as recurrence rate, no significant differences were found between the two groups (P>0.05).

The modified single-site laparoscopic percutaneous extraperitoneal closure of the internal ring using an ordinary taper needle for the repair of pediatric indirect inguinal hernia is a safe and reliable procedure, with minor invasion and satisfied outcome, and no specific device is needed hence more cost-saving. It is easy to learn and perform, and is worthy to be popularized in clinic.

The aim of this study is to examine the efficacy and safety of anterior preperitoneal Kugel patch repair in recurrent inguinal hernias after previous tension-free prosthetic repair and to assess its morbidity and recurrence rate.

Forty patients with recurrent inguinal hernia previously repaired by prosthetic materials were studied retrospectively between January 2006 and January 2016. The hernia types of the recurrence, operative time, complications and recurrence rate were recorded. Visual analogue scale (VAS) were used to record the incidence of chronic pain. All patients underwent transinguinal incision. By removing surrounding scar tissue, previous mesh or plug and cutting transversalis fascia, the Kugel patch was placed preperitoneally between transversalis fascia and peritoneum.

Mean operative time was 50 min (50-65 min). There were 8 minor peritoneum injury during operation. 3 patients had hematoma and 1 patient had seroma. After a mean of 24 months follow-up, chronic pain was improved remarkably from 77.5% preoperatively to 12.5% postoperatively, and no recurrence was detected.

Anterior preperitoneal Kugel patch repair is safe and effective in treatment of recurrent hernia after previous tension-free prosthesis repair, and it is especially suitable for patients with chronic pain following mesh or plug repair.

To study the clinical effectiveness of two different laparoscopic high ligation of hernia sac to treat inguinal hernia in children.

A retrospective analysis was conducted on 150 cases of laparoscopic high ligation of hernia sac in Longjiang Hospital from October 2010 to October 2015. The children were operated with single port and double port laparoscopic high ligation of hernia sac. The operation time, scrotal hematoma, hospitalization time, postoperative VAS score and recurrence rate were compared between the two groups.

The incidence of scrotal hematoma was higher and the operation time was longer in the single port group. These differences were significant. There were no significant differences in hospitalization time, postoperative VAS score and recurrence rate.

The both two methods are safe and effective. The incidence of scrotal hematoma was higher and the operation time was longer in the single port group.