Objective To compare the short-term curative results between Nissen, Thal and Toupet fundoplications in treatment of gastroesophageal reflux(GER) and to provide the basis for operative procedure. Methods Thirty-three male Japan rabbits were randomly divided into six groups: group reflux(n=7), transabdominal Heller’s esophagomyotomy (TAHE)；group Nissen(n=7)，TAHE and Nissen fundoplication；group Thal(n=7)，TAHE and Thal fundoplication；group Toupet(n=7)，TAHE and Toupet fundoplication； control group (n=5)，ventrotomy. The anti-reflux efficacy of fundoplication was evaluated by intraesophageal pH monitoring and MGV（maximal gastric volume sustained by lower esophageal sphincter）4 weeks postoperatively. Results ① The total number of reflux episodes and the reflux ratio（0.83±0.41,2.20%±1.12%） of group Nissen were significantly lower than those of group Thal (2.20±0.45, 4.32%±0.82%) and group Toupet (1.80±0.45, 4.20%±0.57%), respectively (Plt;0.05). ② MGV of group Nissen (233.00±9.44)ml was significantly larger than those of group Thal （203.40±11.13）ml and group Toupet（197.60±10.99）ml, respectively (Plt;0.05). ③There were no significant difference in total number of reflux episodes, reflux ratio and MGV between group Thal and group Toupet (Pgt;0.05).Conclusion Nissen fundoplication was better than Thal and Toupet fundoplications,Thal and Toupet fundoplications are similar in short-term curative result.
ObjectiveTo investigate the clinical effects of laparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication in elderly patients with gastroesophageal reflux disease (GERD). MethodsFrom July 2006 to July 2009, 22 consecutive elderly patients （≥65 years） with GERD underwent laparoscopic hiatus reconstruction associated with Nissen fundoplication， 10 of them underwent laparoscopic Crurosoft patch hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 8 patients) and 12 underwent laparoscopic simple sutured hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 10 patients). Intra and perioperative data including symptoms (heartburn, regurgitation, dysphagia, and respiratory complications), functional evaluations (esophagogastroscopy, manometric evaluations in lower esophageal segment, and 24 h pH-monitoring values) were compared and analyzed. ResultsPatients in 2 groups had similar preoperative values in demographics, symptom scores, functional evaluations, as well as operative data except for mean operative time. Three-month and 1-year follow-up after operation, the results of symptoms scores and functional evaluations of patients in 2 groups compared with preoperative values wear improved （Plt;0.05）, but symptoms scores and functional evaluations of patients in patch group were evaluated to demonstrate more significant improvement than suture group （Plt;0.05）. In suture group, the results of 3 months after operation were better than 1 year after operation, with statistically significant difference （Plt;0.05）. Two patients underwent postoperative intrathoracic immigration of wrap in suture group, but this complication did not happen in patch group （Plt;0.05）. ConclusionsLaparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication is a safe and effective treatment for elderly patients(≥65 years) with GERD.
Achalasia is a rare motor disorder of the esophagus and its etiology and pathogenesis remain unclear. Its clinical presentation typically includes various degrees of dysphagia, regurgitation, aspiration, chest pain and weight loss. The main therapy purpose for achalasia is to reduce lower esophageal sphincter pressure (LESP) so as to alleviate clinical symptoms. There are a variety of treatment methods for achalasia, such as pharmacotherapy, intrasphincteric botulinum toxin injection, endoscopic pneumatic dilatation and surgical intervention. At present, most scholars prefer laparoscopic or thorascopic surgery to achieve satisfactory long-term results including alleviated symptoms and prevention of acid reflux. However, great controversy still exists among scholars regarding the choice of conservative therapy or surgery, transthoracic or transabdominal surgery, optimal distal extent of myotomy, the need and choice of additional antireflux procedures. In this review, we focus on current therapy and progress of achalasia.
ObjectiveTo analyze the effect and prognosis of laparoscopic patch repair of esophageal hiatal hernia.MethodsFrom October 2014 to January 2019, 100 patients with gastroesophageal reflux disease undergoing laparoscopic esophageal hiatus hernia repair were randomly divided into the patch group and the non-patch group. All patients underwent laparoscopic repair of esophageal hiatal hernia plus fundoplication (Nissen’s method). On that basis, the patients in the patch group used special mesh for esophageal hiatal hernia repair, while the ones in the non-patch group did not. All the patients were followed up for a long time. The operative effect, postoperative complication rate, recurrence rate, and satisfaction rate of the patients between the two groups were compared.ResultsA total of 98 patients were successfully followed up for more than one year, including 68 in the patch group and 30 in the non-patch group. One year after surgery, the differences between the patch group and the non-patch group in the improvements of reflux attack, heartburn, dysphagia, and food intake were statistically significant (P<0.05); there was no significant difference between the patch group and the non-patch group in satisfaction rate (82.4% vs. 73.3%, P>0.05); the differences in recurrence rate (2.9% vs. 26.7%) and incidence of dysphagia (47.0% vs. 6.7%) between the patch group and the non-patch group were statistically significant (P<0.05).ConclusionFor the patients with gastroesophageal reflux disease caused by esophageal hiatal hernia, the laparoscopic repair of esophageal hiatal hernia + Nissen fundoplication on the basis of reasonable selection of special mesh for esophageal hiatal hernia can obtain satisfactory clinical effect.