Abstract:

Objective

To explore the application of laparoscopic Nissen fundoplication and Toupet fundoplication in patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease (GERD).

Methods

The clinical data of patients with esophageal hiatal hernia complicated with GERD admitted from April 2022 to April 2023 were retrospectively analyzed. According to different surgical methods, the patients were divided into the Nissen group (undergoing Nissen fundoplication) and the Toupet group (undergoing Toupet fundoplication). Confounding factors in the baseline data of the patients were excluded by the propensity score matching method (caliper value 0.02), and 53 patients with comparable baseline data (P>0.05) were obtained in each group. The statistical analysis software SSPS21.0 was used to analyze and integrate the data. Enumeration data were expressed as［ cases (%)］, and χ² test and Rank Sum test were performed; Measurement data were expressed as (), and independent sample t tests were performed. P<0.05 was considered to indicate a statistically significant difference.

Results

There were no significant differences in intraoperative blood loss,operation time, first exhaust time, drainage tube removal time, and length of hospital stay between the two groups of patients (P>0.05); The incidence of complications in the Toupet group was significantly lower than that in the Nissen group (P<0.05); Six months after the operation, the number of reflux episodes, reflux time, and gastroesophageal reflux disease questionnaire (GERD-Q) scores of the patients in both groups were significantly decreased (P<0.05), and the number of reflux episodes and reflux time in the Nissen group were significantly lower than those in the Toupet group (P<0.05), while there was no significant difference in GERD-Q scores between the groups (P>0.05); Six months after the operation, the lower esophageal sphincter pressure (LESP)and integrated relaxation pressure (IRP) of the patients in both groups were significantly increased (P<0.05),and the distal esophageal contractile integral (DCI) was significantly decreased (P<0.05), while there were no significant differences between the groups (P>0.05); After the operation, the nutritional status of the patients in the Toupet group was significantly better than that in the Nissen group (P<0.05).

Conclusion

Both Nissen fundoplication and Toupet fundoplication can effectively treat esophageal hiatal hernia complicated with GERD.Nissen fundoplication is superior in improving reflux, and Toupet fundoplication has fewer postoperative complications. Clinically, the type of surgery can be selected according to the actual situation.

Key words: Gastroesophageal Reflux, Hernia, Hiatal, Fundoplication, Postoperative Complications