Application of Highly Selective Protective Vagotomy in Laparoscopic Gastric Fundoplication Surgery / 中国微创外科杂志

ABSTRACT

Objective To investigate the safety,feasibility,and efficacy of highly selective protective vagotomy in laparoscopic fundoplication.Methods Clinical data of 78 patients who underwent laparoscopic hiatal hernia repair plus fundoplication(short floppy Nissen procedure)for gastroesophageal reflux disease and hiatus hernia from January 2014 to December 2019 in our hospital were retrospectively analyzed.The patients were divided into two groups:the traditional operation group and the vagus nerve protection group.The operation time,blood loss during operation,hospital stay after operation and the incidence of postoperative complications were compared between the two groups.The GERD Q score,DeMeester score,lower esophageal sphincter pressure(LESP),and control of reflux symptoms at 6 months after operation in the two groups were analyzed.Results Both groups of surgeries were successfully completed,and there were no serious intraoperative side injuries.There was no significant difference between the traditionaloperationgroupandthevagusnerveprotectiongroupinoperationtime[(85.5±13.9)minvs.(88.3±18.6)min,t =0.729,P =0.468],intraoperative blood loss[(18.6±8.6)ml vs.(18.1±8.5)ml,t =-0.221,P =0.825],and postoperative transanal exhaust time[(2.0±0.7)d vs.(1.8±1.0)d,t =-1.227,P =0.224].The postoperative hospital stay in the traditional surgical group was significantly longer than that in the vagus nerve protection group[(9.4±3.0)d vs.(8.2±2.1)d,t =-2.172,P = 0.033].The incidence of surgical complications within 30 d after surgery in the traditional surgical group was 36.8%(14/38),which was significantly higher than that in the vagus nerve protection group[12.5%(5/40),χ2 = 6.267,P = 0.012].The traditional surgical group had a cure rate of 86.8%(33/48)at 6 months after surgery,which was not significantly different from the vagus nerve protection group[85.0%(34/40),Z =-0.232,P =0.816].There were no significant differences in GERDQscore,DeMeester score,LESP between the two groups at 6 months after surgery[(5.6±0.9)points vs.(5.8±0.8)points,t =1.232,P =0.222;(4.1±2.2)points vs.(4.2±2.2)points,t =0.261,P =0.795;(23.2±3.5)mm Hg vs.(23.5±3.8)mm Hg,t = 0.412,P = 0.681].Conclusion It is safe,feasible,and effective to apply the highly selective protective vagotomy in laparoscopic short floppy Nissen fundoplication to protect the vagus nerve.