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SURGICAL REPAIR OF CONGENITAL DEFORMITIES OF DIAPHRAGM IN INFANTS AND CHILDREN

Congenital deformities of the diaphragm include (1) Hiatus hernia; (2) Congenital diaphragmatic hernia; (3) Eventration of deaphragm. Fifty-one cases were seen by the authors in the past 30 years. Each type of the pathologic feature and the experiences in the surgical repair were suggested in this paper. Choice of an appropriate surgical procedure on the basis of its pathoanatomic and pathophysiologic features was emphasized in order to enhance the efficacy of treatment.

Laparoscopic Operation of Gastric and Gastroesophageal Junction Disease (Report of 59 Cases)

Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.

微創一期治療兒童巨大食管裂孔疝合并雞胸一例

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

ObjectiveTo present the safety and efficiency of laparoscopic Nissen fundoplication for hiatal hernia in elderly patients. MethodsClinical 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. ResultsAll 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. ConclusionLaparoscopic Nissen fundoplication is a safe operation for elderly patients with hiatal hernia, and it can achieve good clinical result.

Effect of body mass index on surgical outcomes of laparoscopic surgery for esophageal hiatal hernia: A propensity score matching study

ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.

Investigation of Application of Laparoscopic Hiatus Reconstruction with Crurosoft Patch in Elderly Patients with Gastroesophageal Reflux Disease

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.

Curative effect and prognosis of laparoscopic patch repair of esophageal hiatal hernia

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.

Research Development of The Relationship Between Hiatal Hernia and Respiratory Symptoms

ObjectiveTo introduce the hiatal hernia (HH) and to summarize the research development of relationship between HH and respiratory symptoms. MethodsLiteratures in recent years which about relationship between HH and respiratory symptoms at home and abroad were collected and reviewed. ResultsGastroesophageal reflux disease (GERD), which always be caused by laryngeal airway and other esophageal symptoms, was a common illness and easily be misdiagnosed. One common symptom of the GERD was the HH. For those patients with reflux-associated esophageal symptoms, many of them suffered from HH. The treatment results showed that the endoscopic surgery could relieve the reflux symptom and effectively control the respiratory symptoms. ConclusionsThe HH can increase the risk of respiratory symptoms; an active treatment on the HH can relieve the respiratory symptoms, which is caused by the reflux symptom.

腹腔鏡下食管裂孔疝修補術的臨床療效分析

目的 回顧性分析腹腔鏡下食管裂孔疝修補術的臨床手術效果。 方法 回顧 2013 年 1 月—2015 年 12 月收治的 38 例食管裂孔疝患者的臨床資料，其中 21 例行腹腔鏡手術（腹腔鏡組），17 例行開腹手術（開腹手術組），所有患者均采用食管裂孔疝專用補片修補并加固食管裂孔，縫合膈肌腳，術中行胃底折疊術抗反流（Nissen 胃底折疊術）或改良術式。對比分析兩組患者情況。 結果 所有患者手術均順利完成。腹腔鏡組手術時間平均（110±5）min，術中出血量平均（70±6）mL，術后住院時間平均（8±2）d；開腹手術組手術時間平均（150±6）min，術中出血量平均（150±10）mL，術后住院時間平均（12±2）d；兩組比較差異有統計學意義（P<0.05）。兩組患者隨訪 3～36 個月，平均（20±3）個月，術后主要癥狀均得到緩解。腹腔鏡組術后仍有術前不適癥狀 2 例，燒心反酸1 例，胸骨后疼痛 1 例。開腹手術組復發 1 例，胸骨后疼痛不適 4 例，反酸 3 例。 結論 腹腔鏡下食管裂孔疝修補術相對開腹手術具有手術時間短、術中出血量少及并發癥少等優點，值得臨床推廣應用。

嬰幼兒腹腔鏡下先天性食管裂孔疝修補術圍手術期護理

目的　總結嬰幼兒腹腔鏡下食管裂孔疝修補術圍手術期的護理方法與經驗，以提高護理質量。 方法　對2011年6月－2012年10月收治的8例先天性食管裂孔疝患兒行腹腔鏡下食管裂孔疝修補術的護理方法及要點進行回顧性分析。 結果　患兒均順利完成手術，1例術后第2天開始發熱，并持續高熱伴咳嗽，經補液、抗感染、霧化吸入等治療，1周后體溫恢復正常，傷口愈合良好，但仍有咳嗽，經兒內科會診以支氣管肺炎轉入兒內科治療。其他患兒無并發癥發生，痊愈出院。經隨訪，8例患兒無腹痛腹脹，無疝復發，無食管狹窄等發生。 結論　術前加強飲食指導、體位護理、皮膚護理，術后做好呼吸道管理、胃管護理、積極抗感染治療，預防肺部并發癥等有效護理措施是嬰幼兒腹腔鏡下先天性食管裂孔疝修補手術成功的關鍵。