To comparison the advantages and disadvantages of laparoscopic Toupet and Dor fundoplication in the treatment of hiatal hernia combined with gastroesophageal reflux disease.

Statistics Analysis 127 patients of GERD in our hospital from December 2014 to January 2017, 41 underwent laparoscopic laparoscopic Toupet fundoplication(Toupet Group).86patients underwent laparoscopic laparoscopic Dor fundoplication(Dor Group). Comparing the GerdQ rating scale scores, intraoperative and postoperative recovery and so on the between patients with esophageal reflux conditions, esophageal manometry in three groups.

Two groups of patients were improved significantly compared with preoperative in reflux conditions(P<0.05). Dor group was better than Toupet group in reducing the number of reflux episodes and suppressed the long-reflux, the difference was statistically significant[the number of reflux episodes: (14.36±10.58)vs.(29.83±19.71), t=7.382, P=0.007, the long-reflux: (0.64±0.21)vs.(6.20±3.48), t=10.816, P=0.001]. The postoperative esophageal sphincter pressure and residual pressure increased significantly, the rate of relaxation and GerdQ Q scores reducted significantly compared with preoperative, the differences were statistically significant(P<0.05, for all). Dor group was better than Toupet group in recovery lower esophageal sphincter pressure(mean resting breathing)[(20.69±13.95)mmHg vs.(12.91±6.89)mmHg, t=4.586, P=0.031]. But, the ineffective swallowing was increase in Toupet group compared with the preoperative, the difference was statistically significant[(9.15±6.44)%: (11.25±2.04)%, t=4.104, P=0.033]. There was no significant difference in operative time, blood loss, hospital stay and complications(P>0.05). We followed up these patients for 6~18 months(median 12 months). 6~18 months(median 12 months). There was no significant difference in recurrence[Toupet group: 1case(2.44%), Dor group: 1case(1.12%), χ²=0.292, P=0.589]. There was no significant difference in postoperative complications(χ²=4.362, P=0.359).

It was safe and feasible for this two fundoplications treating HH combined with GERD.But laparoscopicDor fundoplication was better than Toupet fundoplication in reducing the number of reflux episodes and suppressed the long-reflux and increase LES pressure(mean resting respiration)and the incidence of postoperative dysphagia.