Efficacy comparison of laparoscopic novel anti-reflux surgery and traditional fundoplication in the treatment of gastroesophageal reflux disease complicated with hiatal hernia
10.3760/cma.j.cn113855-20250217-00086
- VernacularTitle:腹腔镜新型抗反流术与传统胃底折叠术治疗胃食管反流病合并食管裂孔疝疗效的对比分析
- Author:
Zhitong LI
1
;
Rui ZHANG
;
Chuangye ZHOU
;
Yang FU
Author Information
1. 郑州大学第一附属医院胃肠外科/疝和腹壁外科，郑州450052
- Publication Type:Journal Article
- Keywords:
Gastroesophageal reflux;
Hernia, hiatal;
Fundoplication;
Treatment outcome
- From:
Chinese Journal of General Surgery
2025;40(6):427-431
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of different anti-reflux surgery combined with laparoscopic hiatal hernia repair in the treatment of gastroesophageal reflux disease (GERD) complicated with hiatal hernia.Methods:A retrospective analysis was conducted on 405 patients with GERD and hiatal hernia undergoing laparoscopic hiatal hernia repair combined with different anti-reflux surgery at the First Affiliated Hospital of Zhengzhou University from Jan 2013 to Jun 2019. The patients were divided into four groups based on the anti-reflux surgery: 38 patients underwent Nissen fundoplication (Nissen group), 67 patients underwent Toupet fundoplication (Toupet group), 101 patients underwent Dor fundoplication (Dor group), and 199 patients underwent His angle plasty (His group). The improvement of symptoms, the use of proton pump inhibitor (PPI), surgical outcomes, and postoperative complications were compared among the four groups at 5 years after surgery.Results:Compared with preoperative scores, the scores of acid regurgitation and heartburn in all four groups decreased significantly after surgery (Nissen group: Z=-4.974, -4.905; Toupet group: Z=-9.245, -9.413; Dor group: Z=-8.080, -8.225; His group: Z=-11.705, -11.619, all P<0.05), and there was no significant difference in postoperative symptom scores among the four groups (acid regurgitation: 2.2 vs. 2.0 vs. 1.9 vs. 1.9; heartburn: 2.0 vs. 1.7 vs. 1.7 vs. 1.8, all P>0.05). There was no significant difference in the total effective rate of treatment among the four groups (86.8% vs. 92.5% vs. 87.1% vs. 91.5%, χ2=2.314, P=0.510). Additionally, there was no significant difference in the PPI independence among the four groups (63.2% vs. 61.2% vs. 60.4% vs. 60.3%, χ2=0.120 P=0.989). The incidence of severe dysphagia and abdominal distension was higher in the three fundoplication groups (Nissen, Toupet, and Dor groups) than in the His group (all P<0.05). Conclusions:Laparoscopic hiatal hernia repair combined with different anti-reflux surgery is safe and effective in the long-term treatment of GERD complicated with hiatal hernia. His angle plasty has the advantages of simple surgical operation and low incidence of postoperative dysphagia and abdominal distension, and is a recommended new anti-reflux surgery.
