Clinical Analysis of Laparoscopic Nissen Fundoplication for Hiatal Hernia in Elderly Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YAODan ^1,2 ,  RENZe-qiang ¹ , ZHANGPeng-bo ¹ , ZHANGXiu-zhong ¹ , ZHANGChong ¹ , GONGShuai ^1,2

1. Department of General Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China;
2. Graduate School, Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China;

Corresponding author：

RENZe-qiang, Email: rzq0805@189.cn

Keywords：

Hiatal hernia; Elderly patient; Laparoscopic Nissen fundoplication; Gastroesophageal reflux

DOI：

10.7507/1007-9424.20160085

Video：

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Objective To present the safety and efficiency of laparoscopic Nissen fundoplication for hiatal hernia in elderly patients. Methods Clinical data of 35 elderly patients with hiatal hernia who underwent laparoscopic Nissen fundoplication in The Affiliated Hospital of Xuzhou Medical College between August 2013 and March 2014 was retrospectively analyzed. Results All patients underwent laparoscopic Nissen fundoplication. The operation time was 72-minute in average (65-105 minutes) and intraoperative blood loss was 30 mL in average (10-120 mL). The mean value of postoperative hospital stay was 5-day (3-23 days). Patients' stomachs and esophagus were restored to normal position after surgery. No complication was noted except 2 patients had mild gastroesophageal reflux after operation, and 1 patient suffered from transient dysphagia after operation, all the symptoms subsided after conservative treatment. Afterwards, 33 of them achieved follow-up for 6 to 12 months (mean of 8.5 months), the other 2 patients were lost to follow-up. During the follow-up period, a questionnaire regarding to the criteria for Reflux Diagnostic Questionnaire (RDQ) score were conducted in the 33 patients, and the results showed that the symptoms including acid reflux, heartburn, chest pain, cough, dyspnea, lump sensation in the pharynx, and hoarseness were improved significantly in 6 months after operation (P<0.05), and no recurrence was found during the follow-up period. Conclusion Laparoscopic Nissen fundoplication is a safe operation for elderly patients with hiatal hernia, and it can achieve good clinical result.

Citation： YAODan, RENZe-qiang, ZHANGPeng-bo, ZHANGXiu-zhong, ZHANGChong, GONGShuai. Clinical Analysis of Laparoscopic Nissen Fundoplication for Hiatal Hernia in Elderly Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(3): 319-322. doi: 10.7507/1007-9424.20160085 Copy

1.	田文. 腹腔镜食管裂孔疝修补胃底折叠术. 中国实用外科杂志, 2006, 26(11): 820-822.
2.	褚海波, 仇明, 潘龙文, 等. 腹腔镜Nissen胃底折叠术的临床疗效评价. 腹腔镜外科杂志, 2008, 13(4): 281-283.
3.	张成, 克力木, 牛伟亚, 等. 腹腔镜下胃底Nissen折叠术式治疗食管裂孔疝的临床应用. 中华普外科手术学杂志: 电子版, 2010, 4(1): 53-56.
4.	郑亚杰, 田文, 马冰, 等. 老年食管裂孔疝的腹腔镜治疗. 中华保健医学杂志, 2012, 14(2): 112-114.
5.	郭献廷, 许俊峰, 王育生. 腹腔镜治疗食管裂孔疝的临床应用. 中国现代普通外科进展, 2011, 14(1): 68-70.
6.	Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol, 2001, 96(1): 52-57.
7.	Poclmans J, Tack J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 2005, 54(10): 1492-1499.
8.	Puri V, Felix E, Fitzgibbons RJ Jr. Laparoscopic vs conventional tension free inguinal herniorrhaphy: 2005 society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting debate. Surg Endosc, 2006, 20(12): 1809-1816.
9.	Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc, 1991, 1(3): 138-143.
10.	Geagea T. Laparoscopic Nissen's fundoplication: preliminary report on ten cases. Surg Endosc, 1991, 5(4): 170-173.
11.	Diaz S, Brunt LM, Klingensmith ME, et al. Laparoscopic paraesopha-geal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg, 2003, 7(1): 59-67.
12.	Lamb PJ, Myers JC, Jamieson GG, et al. Long-term outcomes of revisional surgery following laparoscopic fundoplication. Br J Surg, 2009, 96(4): 391-397.
13.	嵇振岭, 李俊生, 尤存忠, 等. 腹腔镜食管裂孔疝修补术的临床分析. 腹腔镜外科杂志, 2010, 15(8): 578-580.
14.	田文. 腹腔镜食管裂孔疝修补术. 中华腹腔镜外科杂志: 电子版, 2010, 3(2): 138-141.
15.	王斌, 张伟, 单成祥, 等. 单纯缝合和补片加固治疗食管裂孔疝的对比研究. 中华胃食管反流病电子杂志, 2014, 1(1): 19-23.
16.	Zornig C, Strate U, Fibbe C, et al. Nissen vs Toupet laparoscopic fundoplication. Surg Endosc, 2002, 16(5): 758-766.
17.	Müller-Stich BP, Holzinger F, Kapp T, et al. Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc, 2006, 20(3): 380-384.
18.	Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg, 2006, 244(4): 481-490.
19.	张哲, 范兴龙, 张璐, 等. 腹腔镜下修补老年食管裂孔疝6例. 中华胸心血管外科杂志, 2014, 30(8): 493-494.
20.	刘正尼, 顾岩. 腹腔镜下治疗食管裂孔疝的进展. 中华胃食管反流病电子杂志, 2014, 1(1): 46-48.
21.	Zacharoulis D, O'Boyle CJ, Sedman PC, et al. Laparoscopic fundoplication: a 10-year learning curve. Surg Endosc, 2006, 20(11): 1662-1670.
22.	Ponsky J, Rosen M, Fanning A, et al. Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair. Surg Endosc, 2003, 17(7): 1036-1041.
23.	Tsimogiannis KE, Pappas-Gogos GK, Benetatos N, et al. Laparos-copic Nissen fundoplication combined with posterior gastropexy in surgical treatment of GERD. Surg Endosc, 2010, 24(6): 1303-1309.
24.	张成, 克力木. 腹腔镜手术治疗食管裂孔疝现状与争议. 中华疝和腹壁外科杂志:电子版, 2011, 5(2): 208-212.
25.	Rijnhart-De Jong HG, Draaisma WA, Smout AJ, et al. The Visick score: a good measure for the overall effect of antireflux surgery?. Scand J Gastroenterol, 2008, 43(7): 787-793.

1. 田文. 腹腔镜食管裂孔疝修补胃底折叠术. 中国实用外科杂志, 2006, 26(11): 820-822.
2. 褚海波, 仇明, 潘龙文, 等. 腹腔镜Nissen胃底折叠术的临床疗效评价. 腹腔镜外科杂志, 2008, 13(4): 281-283.
3. 张成, 克力木, 牛伟亚, 等. 腹腔镜下胃底Nissen折叠术式治疗食管裂孔疝的临床应用. 中华普外科手术学杂志: 电子版, 2010, 4(1): 53-56.
4. 郑亚杰, 田文, 马冰, 等. 老年食管裂孔疝的腹腔镜治疗. 中华保健医学杂志, 2012, 14(2): 112-114.
5. 郭献廷, 许俊峰, 王育生. 腹腔镜治疗食管裂孔疝的临床应用. 中国现代普通外科进展, 2011, 14(1): 68-70.
6. Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol, 2001, 96(1): 52-57.
7. Poclmans J, Tack J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 2005, 54(10): 1492-1499.
8. Puri V, Felix E, Fitzgibbons RJ Jr. Laparoscopic vs conventional tension free inguinal herniorrhaphy: 2005 society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting debate. Surg Endosc, 2006, 20(12): 1809-1816.
9. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc, 1991, 1(3): 138-143.
10. Geagea T. Laparoscopic Nissen's fundoplication: preliminary report on ten cases. Surg Endosc, 1991, 5(4): 170-173.
11. Diaz S, Brunt LM, Klingensmith ME, et al. Laparoscopic paraesopha-geal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg, 2003, 7(1): 59-67.
12. Lamb PJ, Myers JC, Jamieson GG, et al. Long-term outcomes of revisional surgery following laparoscopic fundoplication. Br J Surg, 2009, 96(4): 391-397.
13. 嵇振岭, 李俊生, 尤存忠, 等. 腹腔镜食管裂孔疝修补术的临床分析. 腹腔镜外科杂志, 2010, 15(8): 578-580.
14. 田文. 腹腔镜食管裂孔疝修补术. 中华腹腔镜外科杂志: 电子版, 2010, 3(2): 138-141.
15. 王斌, 张伟, 单成祥, 等. 单纯缝合和补片加固治疗食管裂孔疝的对比研究. 中华胃食管反流病电子杂志, 2014, 1(1): 19-23.
16. Zornig C, Strate U, Fibbe C, et al. Nissen vs Toupet laparoscopic fundoplication. Surg Endosc, 2002, 16(5): 758-766.
17. Müller-Stich BP, Holzinger F, Kapp T, et al. Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc, 2006, 20(3): 380-384.
18. Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg, 2006, 244(4): 481-490.
19. 张哲, 范兴龙, 张璐, 等. 腹腔镜下修补老年食管裂孔疝6例. 中华胸心血管外科杂志, 2014, 30(8): 493-494.
20. 刘正尼, 顾岩. 腹腔镜下治疗食管裂孔疝的进展. 中华胃食管反流病电子杂志, 2014, 1(1): 46-48.
21. Zacharoulis D, O'Boyle CJ, Sedman PC, et al. Laparoscopic fundoplication: a 10-year learning curve. Surg Endosc, 2006, 20(11): 1662-1670.
22. Ponsky J, Rosen M, Fanning A, et al. Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair. Surg Endosc, 2003, 17(7): 1036-1041.
23. Tsimogiannis KE, Pappas-Gogos GK, Benetatos N, et al. Laparos-copic Nissen fundoplication combined with posterior gastropexy in surgical treatment of GERD. Surg Endosc, 2010, 24(6): 1303-1309.
24. 张成, 克力木. 腹腔镜手术治疗食管裂孔疝现状与争议. 中华疝和腹壁外科杂志:电子版, 2011, 5(2): 208-212.
25. Rijnhart-De Jong HG, Draaisma WA, Smout AJ, et al. The Visick score: a good measure for the overall effect of antireflux surgery?. Scand J Gastroenterol, 2008, 43(7): 787-793.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Analysis of Laparoscopic Nissen Fundoplication for Hiatal Hernia in Elderly Patients

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