The Clinical Study Of Treatment For Sliding Hiatus Hernia Through Transabdominal Surgery

The stomach tissue entering into the mediastinum throughesophageal hiatus is named esophageal hiatus hernia. Parts of themhappen because the gastroduodenal content enter into the esophagus,which results in the pathologic changes of the esophagus and othersystems, and the corresponding clinical symptoms. So this kind ofhernia needs surgical treatment. There are two ways to perform theoperation of anti-reflux: one is transabdominal, the other istransthoracic. Though the patients are satisfied with the operations,actually either way exist dysphagia and regurgitation after surgery. Forresolving these problems, we have inspected LESP and LESL duringthe operation of anti-reflux to judge whether the effect of EndoClinchis satisfactory since 1998. There were 42 patients undergoing the transabdominal surgery totreat sliding hiatus hernia who had been inspected LESP LESL and 24hours'PH of the esophagus before and after surgery. They weredivided into three groups: 13 patients were in the Nessen group, 20cases in the floppy Nissen group, another 9 cases in the intraoperativeoesophageal manometry group. There is no postoperative death. Complications occurred in 4patients within one month after operation: In the Nessen group, 2patients suffered from severe dysphagia and 1 from regurgitation;inthe floppy Nissen group, 1 from regurgitation;in the intraoperativeoesophageal manometry group, there are no one suffering fromregurgitation and dysphagia. During follow-up, excellent functionalresults were observed in 31 patients (86.1%), good in 3 (8.3%), fair in1 (2.8%), and poor in 1 (2.8%). Though LESP during intraoperativeoesophageal manometry is higher 2-5mmHg than that after surgeryand LESL is lower 0.3-0.5mmHg, there is no significant differencebetween them (p>0.05).We draw the conclusion as following from the stndy: Surgeryshould be performed in some patients with sliding hiatus hernia ofsevere symptoms and complications. Due to less serious trauma andless complications, the thansabdominal operation is more suitable forpatients with sliding hiatus hernia. If it is possible to performintraoperative oesophageal manometry during the operation ofanti-reflux, LESP and LESL should be inspected to judge that theeffect of EndoClinch is or not satisfactory;If it is not possible toinspect LESP and LESL, we suggest to perform the operation of thefloppy Nissen, although there is no significant difference betweenthem;The intraoperative oesophageal manometry is more suitable tothe doctors who have less experience in this regard.