Cheng Cheng, Wu Yeming, Pan Weihua, Wang Jun, Wu Zhixiang, Lv Fan
Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
J Laparoendosc Adv Surg Tech A. 2019 Oct;29(10):1320-1324. doi: 10.1089/lap.2019.0071. Epub 2019 Jul 26.
Esophageal hiatal hernia can be classified into four types. It has been reported that most complications occurred in type II-IV hernia patients compared with type I hernia. This study aimed to investigate and compare the efficacy, complications, and long-time outcomes after laparoscopic fundoplication between type I and type II-IV hernia patients. Medical records of 110 children who underwent laparoscopic fundoplication during 2008-2017 in our institution were retrospectively analyzed. Information of postoperative symptoms, complications, and quality of life (QOL) were compared between different types. All 110 children underwent laparoscopic fundoplication, and none converted to open surgery. Type I and type II-IV each accounted for 50.9% and 42.8%. There was no significant difference in the perioperative data between type I and type II-IV esophageal hiatal hernia. The follow-up information of 81 children was obtained. The scores of postoperative symptoms were comparable between type I and type II-IV group, except the severity score of reflux symptom was higher in type I hernia patients ( = .032). The difference in the incidence of postoperative complications and recurrence after laparoscopic fundoplication between type I and type II-IV hernia was not significant. The QOL in three aspects improved significantly after laparoscopic fundoplication in all types of esophageal hiatal hernia. Laparoscopic fundoplication was an effective approach for all types of esophageal hiatal hernia. Type II-IV hernia could obtain a comparable therapeutic effect and long-time outcome compared with type I hernia despite its increased complexity of the anatomy and the required laparoscopic repair procedure.
食管裂孔疝可分为四种类型。据报道，与I型疝相比，大多数并发症发生在II-IV型疝患者中。本研究旨在调查和比较I型与II-IV型疝患者腹腔镜胃底折叠术后的疗效、并发症及长期预后。回顾性分析了2008年至2017年在我院接受腹腔镜胃底折叠术的110例儿童的病历。比较不同类型之间术后症状、并发症及生活质量（QOL）的信息。所有110例儿童均接受了腹腔镜胃底折叠术，无一例转为开放手术。I型和II-IV型分别占50.9%和42.8%。I型和II-IV型食管裂孔疝的围手术期数据无显著差异。获得了81例儿童的随访信息。I型和II-IV型组术后症状评分相当，但I型疝患者反流症状严重程度评分较高（P = 0.032）。I型和II-IV型疝腹腔镜胃底折叠术后并发症发生率及复发率的差异无统计学意义。所有类型的食管裂孔疝腹腔镜胃底折叠术后三个方面的生活质量均显著改善。腹腔镜胃底折叠术对所有类型的食管裂孔疝都是一种有效的治疗方法。尽管II-IV型疝的解剖结构更为复杂，所需的腹腔镜修复手术也更为复杂，但与I型疝相比，其可获得相当的治疗效果和长期预后。
