Laparoscopic Esophageal Hiatal Hernia Repair And It's Influence To The Gastrointestinal Hormone

Objectiv:To explore the clinical value of laparoscopic hiatal hernia repair with Dor fund1oplication and the change of gastrointestinal hormone before and after operation.Methods:64 patients with hiatal hernia underwent laparoscopic hiatal hernia repair in minimally invasive center of NanKai hospital,Sep 2006 to Jan 2009. 64 patients with hiatal hernia randomized into two groups.23 patients underwent nissen fundoplication,and the other 41 received Dor fundoplication.The patients evaluated before and after operation,including gastroscopy,upper gastrointestinal radiography,esophageal manometry,24-hour esophageal pH, fluctuation of motilin and gastrin.After 4-89 months follow-up,we analysed the indexes and observed the effectiveness of laparoscopic hita1 hernia with Dor fundoplication,and came to know the effect of the gastrointestinal hormone in the pathogenesis and to the operation.Results:After 1 week of operation,14 patients(Nissen 6,Dor 8) revealed substem chocking without reflux,Regurgitation and substern pain.The symptoms of 11 of them disappeared with semi-liquid diet,but the other 3 patients didn't until 4 months after operation.However,they have no dysphagia or substern pain.1 of them underwent gastroscopic balloon dilatation treatment.After 4 months follow-up,the symptoms of 46 patients disappeared completely,13 of them alleviated and 2 of them changed little whose gastroscopy examination,24-hour esophageal pH and manometry were normal.The sensitivity of the gastroscopy is 73.4%and that of upper gastrointestinal radiography is 65.6%in pre-operative diagnosis.The accuracy of diagnosis would raise,with the assistance of 24-hour esophageal pH and manometry.The motilin of the patients was lower than normal people,and there was no difference no matter which fundoplication they got.The patients whose Demeester score were under 14 had obviously reflux,belching,gas bloation,flatulence and so on.The levels of the motilin of mild or moderate patients are normal,but the ones whose Demeester score under 23 or took anti-acid medicine before are high.All of the 64 patients' motilin level raise after operation.there is no statistic difference between Dor group and Nissen group(p＞0.05).Conclusions:Gastroesophageal reflux is the main reason for surgical treatment in our department(87.5%).Gastroscopy have higher sensitivity than upper gastrointestinal radiography.The diagnose will be more accurate if combined with gastroscopy,radiography,24-hour esophageal pH and manometry(92.2%). 180°anterior fundoplication will be as well as Nissen in short period,moreover,it can redue the dysphagia after operation.The level of motilin is lower than that of normal persons,but the fluctuation of gastrin has no definitely association with hiatal hernia.But the 180°Dor anterior fundoplication will get the excellent result as well as 360°Nissen fundoplication,compaired with the two gastrointestinal hormone.However,what reason cause the hormone increase need further study.