Objective To investigate the efficacy and safety of laparoscopic repair of paraesophageal her-nia. Methods Sixty-one patients underwent laparoscopic repair of paraesophageal hernia, all having laparo-scopic Toupet fundoplication. Results Laparoscopic repair of paraesophageal hernia was completed success-fully in all the 61 patients. The average operation time was 110 min and the blood loss 10～50 ml. Postopera-tive oral feedings were resumed 24～48 h after surgery, and no postoperative complication occurred. The me-dian postoperative hospital stay was 5.7 d. Conclusion Laparoscopic repair of paraesophageal hernia is an effective and safe surgical procedure of minimal invasion.

Objective : To explore the etiology, clinical manifestations, diagnosis, differential diagnosis and treatment of idiopathic gingival fibromatosis, and to provide references for clinical diagnosis and treatment. Methods : The clinical data and related literatures of a case of idiopathicgingival fibroma that occurred in the oral cavity were retrospectively analyzed. Results : Total periodontal treatment was performed for the patient, and the gingival morphology was improved after periodontal surgery in the anterior region. Idiopathic gingival fibromatosis is a rare disease characterized by gingival tissue hyperplasia. The etiology and pathogenesis are unknown. The disease can occur in young children. Generally, it occurs after the permanent teeth erupt, and it manifests as extensive gingival hyperplasia, which can affect the entire gingival margin, gingival papilla and attached gingival, and can even reach the membrane-gingival junction. The pathological changes include thickening of the spinous layer of the gingival epithelium, significant increases in the epithelial styloid process, increases in the connective tissue volume, and filling with large collagen fiber bundles and a large number of fibroblasts. The blood vessels are relatively small, and inflammation is not obvious. Clinically, this disease needs to be distinguished from drug-induced gingival hyperplasia and chronic gingivitis with hyperplasia as the main manifestation. At present, the treatment of idiopathic gingival fibromatosis is mainly gingival angioplasty. The disease easily relapses after surgery. The recurrence rate is related to the quality of oral hygiene. After recurrence, it can be treated again. Conclusion Idiopathic gingival fibromatosis is relatively rare, and the diagnosis mainly depends on the history of inquiry, clinical manifestations and pathological examination. The treatment is mainly surgical resection, and future research should focus on finding a more effective treatment.

A large number of studies have confirmed that periodontitis is closely related to systemic multisystem diseases. Local inflammation of periodontal tissue may cause systemic inflammation. As an inflammatory factor, C-reactive protein (CRP) is widely used to monitor various inflammatory states. CRP is not only highly related to periodontitis but also closely related to systemic diseases. This article reviews the relationship between periodontitis and systemic disease epidemiology as well as the mechanism of CRP in the relationship between them. The literature review shows that periodontitis is closely related to cardiovascular diseases, diabetes, premature and low-birth-weight infants, chronic kidney disease, rheumatoid arthritis and other systemic diseases. Periodontitis, as a chronic inflammatory disease, can increase the level of serum CRP, thus increasing the risk of cardiovascular disease and affecting blood glucose control in diabetic patients, which may be related to the increased risk of premature delivery and low-birth-weight infants, may affect the development of chronic kidney disease, and may be used as one of the sensitive indicators of rheumatoid arthritis in the active stage. Through periodontal treatment, serum CRP levels can be reduced, which is helpful for the treatment of systemic diseases. CRP levels can be used as indicator for prevention, diagnosis and treatment of periodontitis and systemic diseases.

OBJECTIVETo compare the efficacy and safety among laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease (GERD).

METHODSClinical data of 276 patients of hiatal hernia complicated with GERD undergoing operation in our hospital from December 2012 to January 2015 were retrospectively analyzed, including 149 patients of laparoscopic Nissen fundoplication (Nissen group), 41 of laparoscopic Toupet fundoplication (Toupet group), and 86 patients of laparoscopic Dor fundoplication (Dor group). Esophageal reflux status, esophageal manometry, GERD Q rating scale, and postoperative recovery were compare among the three groups.

RESULTSReflux status was improved significantly in the three groups after operation(all P<0.05),except that the efficacy in reducing reflux episodes and reflux longest time was not obvious in Toupet group(P>0.05). There were no significant differences in postoperative reflux time, acid reflux time ratio, reflux longest time ratio, DeMeester score among the three groups (all P>0.05). Pairwise comparison showed that Dor group was significantly better than Toupet group in reducing the number of reflux episode(14.36±10.58 vs. 29.83±19.71) and long-reflux (0.64±0.21 vs. 6.20±3.48)(both P<0.05), but Nissen group was better than these two groups in reducing the number of long-reflux (0.38±0.16, P<0.05). As compared to pre-operation, the postoperative esophageal sphincter pressure and residual pressure increased significantly, and the relaxation rate reduced significantly (all P<0.05), while the episode of ineffective swallowing increased significantly in Toupet group (11.25±2.04 vs. 6.36±3.26, P<0.05). The contrast in esophageal manometry between Toupet and Dor group showed that Dor group was better than Toupet group in the recovery of lower esophageal sphincter pressure (mean resting breathing) [(20.69±13.95) mmHg vs.(12.91±6.89) mmHg] and the decrease of ineffective swallowing [9.15±6.44 vs. 11.25±2.04](both P<0.05), while such results of Dor group were similar to Nissen group[(19.87±10.40) mmHg, 6.15±2.95, all P>0.05]. The GERD Q scores were significantly decreased after operation in 3 groups(Nissen group:10.94±2.20 vs.7.41±1.43, t=11.667, P=0.001; Toupet group: 10.91±2.02 vs.7.18±1.33, t=5.109, P=0.005; Dor group: 10.69±1.69 vs. 7.10±1.30, t=7.610, P=0.002). There was no significant difference in GERD Q scores among three groups (F=1.465, P=0.207). The operative time, blood loss, hospital stay and complications were not significantly different among 3 groups (all P>0.05). Follow-up period was 12-51 months (median 19 months), and no significant difference in recurrence was found [Nissen group: 2 cases (1.3%), Toupet group: 1 case (2.4%), Dor group: 1 case (1.2%), χ=0.363, P=0.834].

CONCLUSIONSIt is safe and feasible for these three laparoscopic fundoplications to the treatment of hiatal hernia complicated with GERD. But laparoscopic Nissen and Dor fundoplication are better than Toupet fundoplication in reducing the number of reflux episodes, suppressing long reflux, increasing lower esophageal sphincter pressure (mean resting respiration) and decreasing the incidence of postoperative dysphagia.

Blood Loss, Surgical ; Comparative Effectiveness Research ; Endoscopy, Gastrointestinal ; methods ; Esophageal Sphincter, Lower ; physiology ; surgery ; Fundoplication ; methods ; Gastroesophageal Reflux ; complications ; surgery ; Hernia, Hiatal ; complications ; surgery ; Humans ; Length of Stay ; Manometry ; Operative Time ; Postoperative Complications ; epidemiology ; Recurrence ; Retrospective Studies ; Treatment Outcome