To analyze the clinical efficacy between laparoscopic surgery and open surgery for treating infantrle esophageal hiatal hernia (EHH).

A total of 46 infants with EHH who underwent surgical treatment at Kunming Children′s Hospital from January 2017 to September 2023 were selected as research subjects. Patients were divided into two groups based on the surgical method: the open surgery group (n=22, received open surgery for EHH repair and Nissen fundoplication) and the laparoscopic group (n=24, received laparoscopic surgery for EHH repair and Nissen fundoplication). The surgical treatment, incidence of postoperative complications and EHH recurrence of two groups were collected by retrospective analysis method, and were compared Mann-Whitney U test, continuity-corrected chi-square test, or Fisher′s exact test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. Guardians of the patients were informed and consented to the diagnosis and treatment, and they signed informed consent forms for clinical research.

All 46 cases underwent successful surgery without any fatalities. The laparoscopic group had a longer surgical duration compared to the open surgery group [192.0 min (112.5 min, 243.8 min) vs 97.5 min (81.0 min, 120.0 min), Z=-3.59, P<0.001]. Time to oral intake post-operation was shorter in the laparoscopic group compared to the open surgery group [2.0 d (2.0 d, 4.0 d) vs 4.0 d (3.0 d, 4.0 d), Z=-2.39, P=0.017]. There was no statistically significant difference between the two groups in terms of intraoperative blood loss or length of hospital stay (P>0.05). Postoperative complications in the laparoscopic group included recurrence in 5 cases (20.8%), abdominal distension in 1 case (4.2%), vomiting in 4 cases (16.7%), gastroesophageal reflux (GER) in 3 cases (12.5%), gastrointestinal bleeding in 2 cases (8.3%), and 1 case (4.2%) requiring reoperation. In the open surgery group, postoperative complications included abdominal distension in 1 case (4.5%) and GER in 1 case (4.5%). There was no statistically significant difference between the two groups regarding recurrence, incidences of abdominal distension, vomiting, GER, gastrointestinal bleeding, or rate of need for reoperation (P>0.05). Out of 42 followed-up cases with an average follow-up duration of 27.6 months post-operation (ranging from 1 to 83 months), vomiting symptoms disappeared, and normal growth and development were observed. One case in the open surgery group experienced long-term symptoms of GER such as acid regurgitation and chest pain. In the laparoscopic group, 5 cases experienced recurrence post-operation, with 4 cases showing improvement through conservative treatment and 1 case achieving cure after laparoscopic re-repair due to ineffective conservative treatment.

Both laparoscopic surgery for EHH repair and Nissen fundoplication, and open surgery for EHH repair and Nissen fundoplication can effectively treat infantile EHH. Compared to open surgery, laparoscopic repair of EHH and Nissen fundoplication demonstrates advantages such as an earlier start of oral intake post-operation, smaller incisions, and improved aesthetic outcomes.