Laparoscopic surgical management of complex gastroesophageal reflux disease with hiatal hernia: key techniques and reoperative strategies
10.3760/cma.j.cn113855-20250406-00206
- VernacularTitle:腹腔镜手术治疗复杂胃食管反流病合并食管裂孔疝的关键技术与再手术策略
- Author:
Minjun XIA
1
;
Menghui ZHOU
;
Zhihao ZHU
;
Jinlei MAO
;
Zhifei WANG
Author Information
1. 浙江中医药大学第二临床医学院，杭州 310000
- Publication Type:Journal Article
- Keywords:
Gastroesophageal reflux;
Hernia, hiatal;
Fundoplication;
Reoperation
- From:
Chinese Journal of General Surgery
2025;40(6):432-438
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the key technical aspects of laparoscopic anti-reflux surgery (LARS) in complex gastroesophageal reflux disease (GERD) with hiatal hernia (HH) and evaluate the feasibility and efficacy of reoperation.Methods:A retrospective analysis was conducted on 28 patients with complex GERD treated at Zhejiang Provincial People's Hospital from Feb 2020 to May 2024. Preoperative examinations were recorded, and surgical videos were reviewed to reconstruct operative time, critical intraoperative steps, complications, and management techniques. Postoperative follow-up via telephone and outpatient visits assessed symptom relief, complications, and medication use.Results:All 28 patients (4 robotic-assisted and 24 conventional laparoscopic surgeries) successfully underwent LARS, with an operative duration of (152.6±10.3) minutes and a postoperative hospital stay of (4.0±1.9) days. Large HH 9 cases, intraoperative bleeding 6 cases, pleural rupture 3 case, and esophageal perforation 1 case, preoperative diagnoses included short esophagus 2 cases and 7 redo surgeries. The overall recurrence rate was 11%. Postoperative complications occurred in 14%. The redo surgeries group achieved 71% symptom resolution. At 1-12 months of follow-up, 82% of patients were asymptomatic, and 82% discontinued proton pump inhibitor therapy.Conclusions:Complex scenarios requiring specialized techniques in LARS increase surgical difficulty and risks. Standardized management of the hernia sac, hiatal repair, neurovascular protection, identification of anatomical landmarks in reoperations, selection of biological mesh, and adhesiolysis may reduce recurrence rates and complication risks.
