Background and Aims:Laparoscopic hiatal hernia repair(LHHR)is the gold-standard surgical treatment for hiatal hernia(HH),but postoperative recurrence remains a challenge due to hiatal enlargement and disruption of the phrenoesophageal ligament.This study aimed to assess the feasibility,safety,and short-term efficacy of a novel three-dimensional small intestinal submucosa(3D-SIS)patch designed for circumferential crural reinforcement and ligament-like reconstruction in a porcine LHHR model.Methods:Twelve healthy pigs(35-40 kg)were equally randomized into non-mesh group,SIS flat patch group,and 3D-SIS patch group.All animals underwent LHHR and Nissen fundoplication under general anesthesia.In the non-mesh group,the hiatal defect was closed with interrupted sutures.In the SIS flat patch group,a U-shaped SIS patch was placed posterior to the esophagus to reinforce the crura and fixed with medical glue.In the 3D-SIS patch group,an intraoperatively assembled three-dimensional patch was applied,consisting of an upper keyhole-shaped layer for circumferential diaphragmatic reinforcement,a tubular middle part encircling the abdominal esophagus,and a lower small keyhole-shaped patch covering the gastroesophageal junction,all fixed with medical glue.After 3 months,laparotomy was performed to assess recurrence,patch integration,and complications,followed by biomechanical and histological evaluations.Results:All procedures were completed successfully with no deaths or major complications.Operative time was slightly longer in the patch groups,while blood loss was similar.No hernia recurrence or patch migration was observed at 3 months.Biomechanical testing revealed higher ultimate load and Young's modulus in both SIS groups than in the non-mesh group.Histological analysis demonstrated neovascularization and collagen deposition in the patch groups,with the 3D-SIS patch showing more complete circumferential integration and ligament-like tissue formation.Conclusion:The 3D-SIS patch is feasible and safe in porcine LHHR.It provides circumferential diaphragmatic reinforcement and promotes phrenoesophageal ligament-like regeneration,offering a new concept for reducing postoperative recurrence and reconstructing the anti-reflux barrier.

Background and Aims:Laparoscopic hiatal hernia repair(LHHR)is the gold-standard surgical treatment for hiatal hernia(HH),but postoperative recurrence remains a challenge due to hiatal enlargement and disruption of the phrenoesophageal ligament.This study aimed to assess the feasibility,safety,and short-term efficacy of a novel three-dimensional small intestinal submucosa(3D-SIS)patch designed for circumferential crural reinforcement and ligament-like reconstruction in a porcine LHHR model.Methods:Twelve healthy pigs(35-40 kg)were equally randomized into non-mesh group,SIS flat patch group,and 3D-SIS patch group.All animals underwent LHHR and Nissen fundoplication under general anesthesia.In the non-mesh group,the hiatal defect was closed with interrupted sutures.In the SIS flat patch group,a U-shaped SIS patch was placed posterior to the esophagus to reinforce the crura and fixed with medical glue.In the 3D-SIS patch group,an intraoperatively assembled three-dimensional patch was applied,consisting of an upper keyhole-shaped layer for circumferential diaphragmatic reinforcement,a tubular middle part encircling the abdominal esophagus,and a lower small keyhole-shaped patch covering the gastroesophageal junction,all fixed with medical glue.After 3 months,laparotomy was performed to assess recurrence,patch integration,and complications,followed by biomechanical and histological evaluations.Results:All procedures were completed successfully with no deaths or major complications.Operative time was slightly longer in the patch groups,while blood loss was similar.No hernia recurrence or patch migration was observed at 3 months.Biomechanical testing revealed higher ultimate load and Young's modulus in both SIS groups than in the non-mesh group.Histological analysis demonstrated neovascularization and collagen deposition in the patch groups,with the 3D-SIS patch showing more complete circumferential integration and ligament-like tissue formation.Conclusion:The 3D-SIS patch is feasible and safe in porcine LHHR.It provides circumferential diaphragmatic reinforcement and promotes phrenoesophageal ligament-like regeneration,offering a new concept for reducing postoperative recurrence and reconstructing the anti-reflux barrier.

Objective:To evaluate the feasibility and safety of laparoscopic surgery of hiatal hernia with gastric volvulus.Methods:A retrospective study was conducted to analyze the clinical data of 29 cases of hiatal hernia with gastric volvulus undergoing laparoscopic mesh repair and fundoplication at Beijing Chao-Yang Hospital from Jun 2021 to Dec 2022. Fundoplication was performed according to esophageal motility. The general data, operation times, intraoperative blood loss, percentage of intrathoracic stomach, hernia and gastric volvulus classification, conversion to open surgery, post-operative hospital stay and complications, symptom improvement rate, post-operative satisfaction were analyzed.Results:Chronic obstruction symptoms were the most common complaint among the 29 patients. All the operations were done laparoscopicaly with no conversion case,19(65%) cases with type Ⅲ hiatal hernia, 20(70%)　cases with organoaxial gastric volvulus, average operating time was (110.2±33.3)min, average blood loss was (12.6±7.0)ml, percentage of intrathoracic stomach 75.9%±15.8%, length of hernia defect was (6.6±1.2)cm, width of hernia defect was (5.0±1.1)cm .Average post-operative hospital stay was (6.4±1.7) days, perioperative complications were pneumonia(7%) ,atelectasis(7%) and gastric motility disorder(3%). All the patients were followed up for 15 to 32 months, without report of patch infection, long-term chronic pain, intestinal obstruction and hernia recurrence. Postoperative symptom improvement rate was 90%,postoperative satisfaction rate was 90%.Conclusion:Laparoscopic surgery of hiatal hernia with gastric volvulus is a safe, feasible and effective method with satisfactory results.

Objective:To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).Methods:The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion. Results:(1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF-36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF-36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF-36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF-36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF-36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF-36 of social function before and after LHHR was 71±24 and 81±18, the score of SF-36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF-36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF-36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery ( t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR ( P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR ( P<0.05). Conclusions:LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.

Objective:To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).Methods:The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion. Results:(1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF-36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF-36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF-36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF-36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF-36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF-36 of social function before and after LHHR was 71±24 and 81±18, the score of SF-36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF-36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF-36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery ( t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR ( P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR ( P<0.05). Conclusions:LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.

Objective:To investigate the clinical result of biological mesh and synthetic mesh in the repair of hiatal hernia.Methods:a prospective cohort study was conducted to collect and analyze the clinical data of 60 patients with hiatal hernia who were treated at Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University from May 2019 to Jan 2020. Intraoperative blood loss, hospital stay, clinical symptoms (heartburn, acid regurgitation, belching, early satiety, chest pain), VAS score, postoperative recurrence rate and complications were evaluated.Results:There was no significant difference in the overall repair effect between biological mesh group and synthetic mesh group ( P>0.05). All of the 60 patients underwent successful laparoscopic hiatal hernia repair and fundoplication. There were no massive bleeding caused by organ or vascular injury, and no peri-operative death. No recurrence of hiatal hernia, massive hemorrhage, pneumothorax, pleural effusion, gastrointestinal fistula, mediastinal infection or abscess were found during the follow-up of 6 months. Conclusion:There is no significant difference in short-term clinical effect between the use of biological mesh and synthetic mesh after hiatal hernia repair.

Objective:To investigate the application value of different types of acellular matrix graft biological meshes in inguinal hernia repair of adolescents.Methods:The retrospective cohort study was conducted. The clinical data of 159 adolescent patients with inguinal hernia who were admitted to Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2013 to June 2018 were collected. There were 155 males and 4 females, aged from 13.0 to 18.0 years, with a median age of 15.0 years. Of the 159 patients, 42 undergoing traditional high ligation of hernia sac were divided into traditional operation group, 61 undergoing Lichtenstein hernia repair using domestic cross-linked acellular matrix graft biological meshes were divided into domestic biological mesh group, and 56 undergoing Lichtenstein hernia repair using imported non cross-linked acellular matrix graft biological meshes were divided into imported biological mesh group. Observation indicators: (1) surgical situations; (2) postoperative recovery; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detected postoperative recovery and complications of patients up to June 2019. Measurement data with skewed distribution were represented as M (range), comparison between multiple groups was analyzed using the Kruskal-Wallis H test, and paired comparison between groups was analyzed using the Nemenyi test. Count data were described as absolute numbers, comparison between multiple groups was analyzed using the chi-square test or Fisher exact probability, and paired comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison between groups was corrected using the Bonferroni method. Results:(1) Surgical situations: all the 3 groups underwent inguinal hernia repair successfully. The operation time of the traditional operation group, domestic biological mesh group and imported biological mesh group was 20 minutes(range, 10-25 minutes), 35 minutes (range, 30-40 minutes) and 35 minutes (range, 30-40 minutes), respectively, showing a significant difference among the three groups ( χ2=91.640, P<0.05). There were significant differences in the operation time between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group ( P<0.016 7). There was no significant difference in the operation time between the domestic biological mesh group and the imported biological mesh group( P>0.05). (2) Postoperative recovery: the postoperative recurrence rate of hernia of the traditional operation group, domestic biological mesh group and imported biological mesh group was 7.1%(3/42), 0, 0, respectively, showing a significant difference among the three groups ( χ2=8.150, P<0.05). There were significant differences in the postoperative recurrence rate of hernia between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group ( P<0.016 7). There was no significant difference in the postoperative recurrence rate of hernia between the domestic biological mesh group and the imported biological mesh group( P>0.05). The incidence of seroma of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 17.9%(10/56), respectively, showing a significant difference among the three groups ( χ2=14.929, P<0.05). There were significant differences in the incidence of seroma between the imported biological mesh group and the traditional operation group or between the imported biological mesh group and the domestic biological mesh group ( χ2=6.517, 6.741, P<0.016 7). There was no significant difference in the incidence of seroma between the traditional operation group and the domestic biological mesh group ( P>0.05). The incidence of fat liquefaction of incision of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 1.8%(1/56), respectively, showing no significant difference among the three groups ( P>0.05). Patients with fat liquefaction of incision were cured after the treatment of dressing change. The duration of hospital stay of the traditional operation group, domestic biological mesh group and imported biological mesh group were 3.0 days(range, 2.0-5.0 days), 3.0 days(range, 1.0-5.0 days), 2.5 days(range, 1.0-5.0 days), respectively, showing no significant difference among the three groups ( χ2=0.907, P>0.05). (3) Follow-up: all the 155 patients were followed up for 12-77 months, with a median time of 41 months. None of patients was observed with chronic pain, foreign body sensation or infection during the follow-up. Conclusions:It is safe and effective to repair adolescent inguinal hernia with biological mesh. There was no significant difference in the clinical efficacy between the two different types of acellular matrix graft biological meshes, both of which can be used in repair of adolescent inguinal hernia.