Objective To investigate the clinical efficacy of laparoscopic hiatal hernia repair (LHHR) combined with Nissen, Toupet, or Dor fundoplication.
Methods The retrospective cohort study was conducted. The clinical data of 102 hiatal hernia patients who were admitted to 4 hospitals including Gansu Provincial Central Hospital from January 2019 to December 2023 were collected. There were 46 males and 56 females, aged (54±4)years. Among the 102 patients, 37 cases who underwent LHHR combined with Nissen fundoplication were assigned to the Nissen group, 34 cases who underwent LHHR combined with Toupet fundoplication were assigned to the Toupet group, and 31 cases who underwent LHHR combined with Dor fundoplication were assigned to the Dor group. Observation indicators: (1) surgical conditions and postoperative recovery; (2) dysphagia before and after surgery; (3) gastroesophageal reflux disease questionnaire (GERD‑Q) scores before and after surgery. One‑way analysis of variance (ANOVA) was used for comparison of measurement data with normal distribution among groups. In ANOVA, if there were statistically significant differences among groups, the least significant difference (LSD) method was further used for pairwise compari-son. Repeated‑measures ANOVA was applied for comparison of repeated measure-ment data. Comparison of count data among multiple groups was conducetd using the chi‑square test or Fisher exact probability, and the Dunn-Bonferroni correction was used for further pairwise comparison. Comparison of ranked data between groups was conducted using the Kruskal‑Wallis H test.
Results (1) Surgical conditions and postoperative recovery. There was no significant difference in operation time, volume of intraoperative blood loss, time to postoperative first flatus, length of hospital stay, or the incidence of postoperative in‑hospital dysphagia, abdominal distension, abdominal pain, diarrhea among the three groups (P>0.05). At 12 months after surgery, there was no hernia recurrence in the Nissen group, 1 case of recurrence in the Toupet group, and 1 case of recurrence in the Dor group, showing no significant difference among the three groups (P>0.05). (2) Dysphagia before and after surgery. Before surgery, there was no significant difference in the incidence of dysphagia among the three groups (P>0.05). At 1 month after surgery, the number of patients with dysphagia in the Nissen group, Toupet group, and Dor group was 20, 18, and 7, respectively, showing a significant difference among the three groups (χ²=8.39, P<0.05). There was no significant difference between the Nissen group and Toupet group (P>0.05). There was a significant difference between the Nissen group and Dor group, between the Toupet group and Dor group (χ²=6.98, 6.32, P<0.05). However, at 6 and 12 months after surgery, there was no significant difference in the incidence of dysphagia among the three groups (P>0.05). (3) GERD‑Q scores before and after surgery. The GERD‑Q scores before surgery, at 1 month and 6 months after surgery were 10.8±1.9, 8.5±2.1, 7.1±1.9 of the Nissen group, 11.0±1.6, 8.6±1.9, and 7.1±1.7 of the Toupet group, 10.7±1.6, 8.7±1.9, 7.2±1.8 of the Dor group, respectively. For the GERD‑Q scores of the three groups before and after surgery, there was a significant difference in the time effect (F=104.17, P<0.05), while no significant difference was found in the inter‑group effect and interaction effect (F=0.13, 0.16, P>0.05). Intra-group comparison of GERD‑Q scores in the three groups before surgery, at 1 month and 6 months after surgery showed significant differences respectively (F=38.37, 40.29, 27.20, P<0.05).
Conclusions LHHR combined with Nissen, Toupet, or Dor fundoplication is safe and effective in the treatment of hiatal hernia , which can achieve good anti‑reflux effects. The Dor fundoplication is associated with a lower short‑term incidence of postoperative dysphagia.
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