Objective:To investigate the clinical efficacy of laparoscopic hiatal hernia repair with tunneled esophagogastric fundoplication and diaphragmatic dome suspension-fixation (HHR-TEF-DDSF) in the treatment of gastroesophageal reflux disease.Methods:The retrospective and descriptive study was conducted. The clinical data of 32 patients with gastroesophageal reflux disease who were admitted to Yifu Hospital Affiliated to Nanjing Medical University from October 2024 to June 2025 were collected. There were 20 males and 12 females, aged (68±7)years. All patients underwent laparoscopic HHR-TEF-DDSF. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were expre-ssed as Mean± SD, while measurement data with skewed distribution were expressed as M( Q1, Q3) or M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical and intraoperative conditions. All 32 patients successfully underwent laparoscopic HHR-TEF-DDSF. The operation time was (75±10)minutes, and volume of intraoperative blood loss was 50(50,100)mL. Among the 32 patients, there was no conversion to open surgery, no blood transfusion, no intra-operative complications such as unexpected massive hemorrhage or adjacent organ injury, no intra-operative adverse event or death. (2) Postoperative conditions. For the 32 patients, the time to post-operative first flatus was 1(1,2)days, the time to postoperative first defecation was 1(1,3)days, the time to postoperative first intake of liquid food was 1(1,3)days, the duration of postoperative drainage tube indwelling was 3(3,6)days, the postoperative hospital stay was 6(5,14)days, and the time to relief of postoperative dysphagia was 5(5,8)days. No obvious hiccup was observed in any patient in the short term after surgery. (3) Follow-up. All 32 patients were followed up for 7.5(range, 3.0-11.0)months. Among the 32 patients, 26 cases achieved subjective relief of overall postoperative digestive tract symptoms, and 32 cases achieved subjective relief of overall postoperative respiratory tract symptoms. The proton pump inhibitor (PPI) withdrawal rate was 84.4%(27/32), and the treatment satisfaction rate was 87.5%(28/32). The incidences of postoperative complications inclu-ding abdominal distension, dysphagia, diarrhea, and increased flatus were 21.9%(7/32), 18.8%(6/32), 6.3%(2/32), and 3.1%(1/32), respectively. Dysphagia was significantly relieved in all affected patients within 2 months after surgery, and no patient had persistent dysphagia by the end of the follow-up period. There was no death, symptom recurrence, or reoperation.Conclusion:HHR-TEF-DDSF is safe and feasible in the treatment of gastroesophageal reflux disease, with favorable short-term efficacy.

The esophagogastric junction serves as a natural anti-reflux barrier and possesses a complex anatomical configuration composed of several key components, including the lower esophageal sphincter, diaphragmatic crura, His angle, and phrenoesophageal ligament. Alterations in these anatomical structures or dysfunction thereof may predispose individuals to gastroesophageal reflux disease (GERD). In response to such structural and functional impairments, various therapeutic strategies have been developed. Surgical intervention is currently regarded as an effective approach for fundamentally addressing GERD, with commonly employed techniques including laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic radiofrequency ablation. The author classifies the anti-reflux mechanisms at the esophagogastric junction into intramural and extramural components, and based on this classification, systematically reviews and evaluates the indications and clinical applications of major surgical interventions for GERD, aiming to provide clinicians with evidence-based guidance for selecting appropriate therapeutic modalities.

The esophagogastric junction serves as a natural anti-reflux barrier and possesses a complex anatomical configuration composed of several key components, including the lower esophageal sphincter, diaphragmatic crura, His angle, and phrenoesophageal ligament. Alterations in these anatomical structures or dysfunction thereof may predispose individuals to gastroesophageal reflux disease (GERD). In response to such structural and functional impairments, various therapeutic strategies have been developed. Surgical intervention is currently regarded as an effective approach for fundamentally addressing GERD, with commonly employed techniques including laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic radiofrequency ablation. The author classifies the anti-reflux mechanisms at the esophagogastric junction into intramural and extramural components, and based on this classification, systematically reviews and evaluates the indications and clinical applications of major surgical interventions for GERD, aiming to provide clinicians with evidence-based guidance for selecting appropriate therapeutic modalities.

Objective:To investigate the clinical efficacy of laparoscopic hiatal hernia repair with tunneled esophagogastric fundoplication and diaphragmatic dome suspension-fixation (HHR-TEF-DDSF) in the treatment of gastroesophageal reflux disease.Methods:The retrospective and descriptive study was conducted. The clinical data of 32 patients with gastroesophageal reflux disease who were admitted to Yifu Hospital Affiliated to Nanjing Medical University from October 2024 to June 2025 were collected. There were 20 males and 12 females, aged (68±7)years. All patients underwent laparoscopic HHR-TEF-DDSF. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were expre-ssed as Mean± SD, while measurement data with skewed distribution were expressed as M( Q1, Q3) or M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical and intraoperative conditions. All 32 patients successfully underwent laparoscopic HHR-TEF-DDSF. The operation time was (75±10)minutes, and volume of intraoperative blood loss was 50(50,100)mL. Among the 32 patients, there was no conversion to open surgery, no blood transfusion, no intra-operative complications such as unexpected massive hemorrhage or adjacent organ injury, no intra-operative adverse event or death. (2) Postoperative conditions. For the 32 patients, the time to post-operative first flatus was 1(1,2)days, the time to postoperative first defecation was 1(1,3)days, the time to postoperative first intake of liquid food was 1(1,3)days, the duration of postoperative drainage tube indwelling was 3(3,6)days, the postoperative hospital stay was 6(5,14)days, and the time to relief of postoperative dysphagia was 5(5,8)days. No obvious hiccup was observed in any patient in the short term after surgery. (3) Follow-up. All 32 patients were followed up for 7.5(range, 3.0-11.0)months. Among the 32 patients, 26 cases achieved subjective relief of overall postoperative digestive tract symptoms, and 32 cases achieved subjective relief of overall postoperative respiratory tract symptoms. The proton pump inhibitor (PPI) withdrawal rate was 84.4%(27/32), and the treatment satisfaction rate was 87.5%(28/32). The incidences of postoperative complications inclu-ding abdominal distension, dysphagia, diarrhea, and increased flatus were 21.9%(7/32), 18.8%(6/32), 6.3%(2/32), and 3.1%(1/32), respectively. Dysphagia was significantly relieved in all affected patients within 2 months after surgery, and no patient had persistent dysphagia by the end of the follow-up period. There was no death, symptom recurrence, or reoperation.Conclusion:HHR-TEF-DDSF is safe and feasible in the treatment of gastroesophageal reflux disease, with favorable short-term efficacy.

Gastroesophageal reflux disease (GERD) is a prevalent disorder within the digestive system, characterized by the regurgitation of gastric and duodenal contents into the esophagus or extraesophageal regions, leading to a spectrum of clinical symptoms. The esophagogastric junction serves as the principal area for anti-reflux function, with anomalies in anatomical structures including the lower esophageal sphincter, the crural diaphragm, the phrenoesophageal ligament, and the angle of His as significant factors in the development of GERD. Reconstructive and reparative surgeries based on above anatomical structures are effective methods for treating GERD, with a variety of surgical approaches each offering distinct advantages and focal points. The authors elucidate the anatomical pathogenesis and rational selection of surgical methods for GERD.

Gastroesophageal reflux disease (GERD) is a prevalent disorder within the digestive system, characterized by the regurgitation of gastric and duodenal contents into the esophagus or extraesophageal regions, leading to a spectrum of clinical symptoms. The esophagogastric junction serves as the principal area for anti-reflux function, with anomalies in anatomical structures including the lower esophageal sphincter, the crural diaphragm, the phrenoesophageal ligament, and the angle of His as significant factors in the development of GERD. Reconstructive and reparative surgeries based on above anatomical structures are effective methods for treating GERD, with a variety of surgical approaches each offering distinct advantages and focal points. The authors elucidate the anatomical pathogenesis and rational selection of surgical methods for GERD.

Pancreatic portal hypertension is a rare clinical syndrome which caused by pancreatic disease.The most significant symptoms are isolated gastric varices,splenomegaly and normal liver func-tion.The key of treatment are the primary disease and splenectomy.The prognosis of pancreatic portal hy-pertension depends on pancreatic disease and complications like gastrointestinal bleeding.

Objective To explore the feasibility of laparoscopic-assisted pancreaticoduodenectomy.Methods The clinical data of 5 patients in our hospital from January to May 2010 were analyzed. 2 patients were pre-operatively diagnosed to have lower common bile duct adenocarcinoma, and 2 patients were preoperatively diagnosed to have adenocarcinoma of the descending duodenum, 1 patient was intra-oparatively diagnosed to have pancreatic head cancer. During the operation, laparoscopic exploration was performed, then gallbladder, distant bile duct, distant stomach, duodenum, part of jejunum and head of pancreas were disassociated, then the digestive tract was reconstructed under open abdomen surgery. Results All the operations of the 5 cases were successfully performed, with an average operation time ( 339 ± 54) min and an intra-operative blood loss of (538 ± 106)ml, and there was no intra-operative blood transfusion. The patients'bowel function recovered (4.0 ± 1.0 ) d postoperatively and were discharged ( 15.8 ± 4.7 ) d postoperatively.1 patient developed pancreatic fistula and was cured with conservative treatment. Conclusions Laparoscopicassisted pancreatoduodenectomy is minimally invasive with short operation time and fast postoperative recovery,which is worth of further clinical study.

AIM:To evaluate the relationship between RUNX3,cyclin E,P21,biological features and survival in gastric cancer patients.METHODS:RUNX3 was examined using immunohistochemical staining.Cyclin E and P21 were analyzed by flow cytometry.Survival was evaluated by Kaplan-Meier survival curves.RESULTS:The positive-expression rate of RUNX3,cyclin E and P21 in tumor tissue from 56 patients with gastric cancer were 44.6%,64.3% and 32.1%,respectively.RUNX3 expression was correlated with lymph node metastasis and distant metastasis(P0.05).Using Kaplan-Meier survival curves and the Log-rank test,there was correlation between RUNX3,cyclin E and survival(P0.05).CONCLUSION:RUNX3 may be related with tumorigenesis and tumor progression by affecting P21 expression.The detection of RUNX3 and cyclin E may be helpful in evaluating the clinicopathological parameters and prognosis in gastric carcinoma patients.