Efficacy analysis of two surgical methods for treating infantile esophageal hiatal hernia

doi:10.3877/cma.j.issn.1673-5250.2024.01.004

Objective

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

Methods

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.

Results

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.

Conclusions

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.

Key words: Hernia, hiatal, Gastroesophageal reflux, Herniorrhaphy, Hiatal hernia repair, Laparoscopes, Fundoplication, Laparotomy operation, Infant

图1　1例EHH患儿(男性，生后6个月＋10 d龄)上消化道X射线摄片(箭头所示为右侧膈肌处可见透亮影)　图2　1例EHH惠儿(女性，生后3个月＋15 d龄)上消化道X射线摄片(箭头所示为右侧膈肌处可见片状混杂密度影，内侧可见透亮气体密度灶)注：EHH为食管裂孔疝

表1 2组EHH患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(月，±s)	出生体重(kg，±s)	入院时体重(kg，±s)	合并呼吸道感染[例数(%)]
组别	例数	男	女	年龄(月，±s)	出生体重(kg，±s)	入院时体重(kg，±s)	合并呼吸道感染[例数(%)]
开腹组	22	11(50.0)	11(50.0)	5.6±3.2	3.0±0.4	5.8±1.7	12(54.5)
腔镜组	24	15(62.5)	9(37.5)	5.0±3.1	3.2±0.4	5.6±1.9	17(70.8)
统计量		χ²＝0.73		t＝0.68	t＝－1.39	t＝0.33	χ²＝1.31
P值		0.393		0.498	0.171	0.746	0.253

表1 2组EHH患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(月，±s)	出生体重(kg，±s)	入院时体重(kg，±s)	合并呼吸道感染[例数(%)]
组别	例数	男	女	年龄(月，±s)	出生体重(kg，±s)	入院时体重(kg，±s)	合并呼吸道感染[例数(%)]
开腹组	22	11(50.0)	11(50.0)	5.6±3.2	3.0±0.4	5.8±1.7	12(54.5)
腔镜组	24	15(62.5)	9(37.5)	5.0±3.1	3.2±0.4	5.6±1.9	17(70.8)
统计量		χ²＝0.73		t＝0.68	t＝－1.39	t＝0.33	χ²＝1.31
P值		0.393		0.498	0.171	0.746	0.253

表2 2组EHH患儿围手术期观察指标比较[M(Q₁，Q₃)]

组别	例数	手术时间(min)	术中出血量(mL)	术后开始经口进食时间(d)	术后住院时间(d)
开腹组	22	97.5(81.0，120.0)	5.0(3.0，5.0)	4.0(3.0，4.0)	10.0(8.0，14.0)
腔镜组	24	192.0(112.5，243.8)	5.0(3.0，5.0)	2.0(2.0，4.0)	9.5(6.3，13.5)
Z值		－3.59	－1.11	－2.39	－0.65
P值		<0.001	0.265	0.017	0.515

表2 2组EHH患儿围手术期观察指标比较[M(Q₁，Q₃)]

组别	例数	手术时间(min)	术中出血量(mL)	术后开始经口进食时间(d)	术后住院时间(d)
开腹组	22	97.5(81.0，120.0)	5.0(3.0，5.0)	4.0(3.0，4.0)	10.0(8.0，14.0)
腔镜组	24	192.0(112.5，243.8)	5.0(3.0，5.0)	2.0(2.0，4.0)	9.5(6.3，13.5)
Z值		－3.59	－1.11	－2.39	－0.65
P值		<0.001	0.265	0.017	0.515

表3 2组EHH患儿术后复发率、并发症发生率及再手术率比较[例数(%)]

组别	例数	复发	术后腹胀	术后呕吐	术后GER	术后消化道出血	再手术
开腹组	22	0(0)	1(4.5)	0(0)	1(4.5)	0(0)	0(0)
腹腔镜组	24	5(20.8)	1(4.2)	4(16.7)	3(12.5)	2(8.3)	1(4.2)
χ²值		3.22^a	0.44^a	2.19^a	0.19^a	0.44^a	—^b
P值		0.073	0.507	0.139	0.663	0.507	0.520

表3 2组EHH患儿术后复发率、并发症发生率及再手术率比较[例数(%)]

组别	例数	复发	术后腹胀	术后呕吐	术后GER	术后消化道出血	再手术
开腹组	22	0(0)	1(4.5)	0(0)	1(4.5)	0(0)	0(0)
腹腔镜组	24	5(20.8)	1(4.2)	4(16.7)	3(12.5)	2(8.3)	1(4.2)
χ²值		3.22^a	0.44^a	2.19^a	0.19^a	0.44^a	—^b
P值		0.073	0.507	0.139	0.663	0.507	0.520

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