Clinical effects of robot-assisted esophageal hiatal hernia repair and laparoscopic esophageal hiatal hernia repair: a retrospective comparative study / 中华外科杂志

Objective: To analyze the short-term clinical effects of robot-assisted and laparoscopic repair of the hiatal hernia. Methods: The clinical data of 56 patients underwent minimally invasive hiatal hernia repair from January 2021 to January 2022 in the Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. There were 32 males and 24 females, aging (59.7±10.7) years (range: 28 to 75 years). All patients were divided into laparoscopy group (n=27) and robot group (n=29) according to surgical procedures. Perioperative conditions, hospital stay, and improvement in symptoms before and after surgery were compared between the two groups by the t test, Wilcoxon rank-sum test and χ2 test. Results: All surgical procedures were successfully completed, without conversion to laparotomy or change in operation mode. There were no serious complications related to the operation. The intraoperative blood loss of the robot group was less than that of the laparoscopic group (M (IQR)): (20 (110) ml vs. 40 (80) ml, Z=-4.098, P<0.01). The operation time ((111.7±33.6) minutes vs. (120.4±35.0) minutes, t=-0.943, P=0.350) and hospitalization time ((3.9±1.4) days vs. (4.7±1.9) days, t=-1.980, P=0.053) of the robot group and the laparoscopic group were similar. Follow-up for 12 months after the operation showed no postoperative complications and recurrence. The score of the health-related quality of life questionnaire for gastroesophageal reflux disease in the robot group decreased from 10.8±2.8 before the operation to 6.5±0.6 after the operation, and that in the laparoscopic group decreased from 10.6±2.1 before the operation to 6.3±0.6 after the operation. There was no difference in the influence of different surgical methods on the change in score (t=0.030,P=0.976). Conclusion: Compared with laparoscopic repair of the hiatal hernia, robot-assisted hiatal hernia repair has the advantages of less bleeding, rapid postoperative recovery and good short-term effect.

[Effects of psychological stress on xanthine oxidase expression, activity and related markers in adipose tissue of mice].

OBJECTIVE: To investigate the effects of psychological stress on xanthine oxidase (XO) expression, activity and related markers in adipose tissue of mice. METHODS: Twenty male Kunming mice were randomly divided into two groups (10 in each group), stress group and control group (10 in each group). Stress group were restrained in self-made restraint device for 2 hours per day for 14 days, then blood samples and white adipose tissues(WAT) were collected. The expression levels of XO and NADPH oxidase-4 (Nox-4) in WAT were detected by immunohistochemistry. The expression of XO, Nox-4, antioxidant proteins (manganese superoxide dismutase (Mn SOD), glutathione peroxidase (GSH-Px), and catalase (CAT)), adipocytokines (adiponectin (ADPN), monocyte chemotactic protein 1 (MCP-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)) in WAT were further detected by quantitative PCR. Relative expressions of glucose metabolism (insulin receptor substrate-1(IRS-1) and glucose transporter type 4(GLUT-4)) and thrombin(tissue factor (TF) and plasminogen activator inhibitor 1 (PAI-1))were measured. XO activity and serum concentrations of (triglyceride (TG), total cholesterol (T-Cho), free fatty acid, (FFA), and uric acid (UA)) were detected by ELISA. RESULTS: XO expressed in stress mice inguinal WAT was deeper and more abundant than that of control group, mainly expressed in adipocytes. RT-PCR and ELISA results showed that the levels of XO mRNA, serum XO concentration and the activities of XO enzyme in WAT of stress group were significantly higher than those of control group(P ＜0.01). Compared with control group the concentrations of free fatty acid (FFA) and uric acid (UA) in stress group were increased significantly than in control group (P＜ 0.01). Nox-4 positive cells mainly expressed in adipocytes. The expression of Nox-4 in WAT of stress group was significantly higher(P ＜0.01); The levels of antioxidant proteins (Mn-SOD, GSH-Px, Catalase) in WAT of stress group were significantly lower (P＜ 0.01). WAT in stress group showed a large number of infiltration reactions and inflammatory changes of monocytes, neutrophils, eosinophils and plasma cells. Stress significantly decreased the expression of adiponectin in WAT, and significantly increased the expressions of MCP-1, IL-6 and TNF-α (P＜0.01). The levels of IRS-1 and GLUT-4 in WAT of stress mice were increased significantly (P＜ 0.01). The expressions of TF and PAI-1 in WAT of stress mice and blood concentrations were significantly higher (P＜0.01). CONCLUSION: Stress can induce excessive expressions of XO in adipose tissue, which eventaully can lead to adipose inflammation, glycometabolism and abnormal prothrombin.

Clinical study of argon plasma coagulation combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia with Barrett esophagus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of argon plasma coagulation (APC) combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia associated with Barrett esophagus.</p><p><b>METHODS</b>A total of 61 cases of hiatal hernias with Barrett esophagus from June 2010 to January 2014 in the Department of Minimal Invasive Surgery, Hernia and Abdominal wall Surgery, People's Hospital of Xinjiang Uyhur Autonomous Region were prospectively enrolled and were randomly allocated into two groups by computer system. Twenty-nine patients received esomeprazole 40 mg/d after APC treatment for 8 weeks (APC with medicine group). Thirty-two patients underwent laparoscopic hiatal hernia repair and Nissen fundoplication after APC treatment (APC with surgery group). All the patients were reviewed by gastroscope and pathologic examination at half a year and one year after operation respectively. Differences of disease improvement and recurrence between the two groups were evaluated.</p><p><b>RESULTS</b>In APC with medicine group, the Barrett's esophagus was relieved after one or two times of APC treatment, however, gastroscope and pathology revealed recurrence of Barrett's esophagus in 7 cases at half a year, and cumulative 16 cases of recurrences were detected after one year follow-up(16/29, 55.2%). In APC with surgery group, only one patient had recurrent Barrett's esophagus at half a year, and a total of two at one year follow-up by gastroscope examination(2/32, 6.3%). Significantly low recurrence rate of Barrett's esophagus was observed in APC with surgery group compared to APC with medicine group(P<0.01). Furthermore, recurrent hiatal hernia was detected in only one case in APC with surgery group. No esophageal cancer was found in both groups during follow-up.</p><p><b>CONCLUSION</b>APC combined with laparoscopic hiatal hernia repair and fundoplication is an ideal method for patients with hiatal hernia and Barrett's esophagus.</p>