To evaluate the therapeutic efficacy of applying the "Four-in-One" concept in the repair of hiatal hernia and fundoplication surgery.

A retrospective analysis was conducted on the data and surgical videos of 82 patients who underwent hiatal hernia repair and fundoplication surgery at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2021 to January 2022. Among them, 40 patients underwent fundoplication using laparoscopic modified Nissen fundoplication combined with the "Four-in-One" technique for the treatment of the esophagogastric junction (study group), while 42 patients underwent laparoscopic modified Nissen fundoplication alone (control group). Demographic, perioperative, and quality of life outcome data were analyzed.

Compared to the study group, the control group exhibited a superior trend in terms of operative time and blood loss [(151.86±38.44) minutes vs (171.82±38.07) minutes, P=0.021; (94.50±49.61) ml vs (113.81±56.35) ml, P=0.104]. In the study group, 8 patients (20%) experienced postoperative dysphagia, slightly higher than the 5 cases (11.9%) in the control group. However, at six months postoperatively, the study group demonstrated significantly better Likert prognosis scores compared to the control group (Fisher's exact test, P=0.028). Moreover, 67.5% of the study group's patients self-assessed as asymptomatic (Grade 1) in the past six months, which was significantly higher than the 40.5% in the control group. Additionally, among patients defined as having no improvement/recurrence/deterioration of symptoms (defined as Grades 4 and 5), the control group had 6 cases and 2 cases, while the study group had no patients reporting these two levels of severity.

The application of the "Four-in-One" concept in the treatment of the esophagogastric junction can improve postoperative satisfaction and quality of life for patients, albeit with increased operative time and bleeding risk. Prospective experiments are needed to validate the conclusions of this study.