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.
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.
ObjectiveTo compare the clinical efficacy of different surgical approaches for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). MethodsThe clinical data of the patients with Siewert type Ⅱ AEG who received sugeries in the Department of Thoracic Surgery of Gansu Provincial People's Hospital from August 2014 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the surgical approach: a transabdominal group (transabdominal diaphragmatic esophageal hiatus approach) and a combined group (thoracoabdominal combined with right thoracic approach). Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term efficacy of the two groups. Results A total of 87 patients were enrolled. There were 48 patients (31 males and 17 females, with an average age of 60.85±8.47 years) in the transabdominal group, and 39 patients (25 males and 14 females, with an average age of 61.13±8.51 years) in the combined group. There was no statistical difference between the two groups in the baseline indicators such as gender, age, tumor size and stage (P>0.05). Compared with the combined group, the operation time, intraoperative blood loss, postoperative bed rest time, postoperative total drainage volume were shorter or less, and the visual analogue scale score on the 3rd day after surgery were lower in the transabdominal group (P<0.05). However, the total number of lymph nodes dissected, the number of thoracic lymph nodes dissected and the number of positive thoracic lymph nodes in the combined group were larger than those in the transabdominal group, and the differences were statistically significant (P=0.001). The median survival time in the combined group and transabdominal group was 25.85 months and 20.86 months, respectively. The 3-year overall survival rate of the combined group was higher than that of the transabdominal group (46.2% vs. 38.9%, χ2=5.995, P=0.014). However, there was no statistical difference between the two groups in the postoperative catheter time, esophageal and gastric resection margin distance, number of abdominal lymph nodes dissected, number of positive abdominal lymph nodes, or incidence of postoperative complications (P>0.05). ConclusionFor patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction, thoracoabdominal combined with right thoracic approach is safe and effective, and has advantages in thoracic lymph node dissection, bringing more benefits to the patients, so it is recommended to be popularized in clinical practice.
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.
ObjectiveTo investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).MethodsFrom January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ2=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ2=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.ConclusionsAccording to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.
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.