To measure the esophageal hiatus area (HSA) and esophageal cross-sectional area (ESA) in healthy adults, establish the normal reference value for HSA, and calculate the ESA/HSA ratio, thereby providing morphological evidence for the diagnosis of hiatal hernia (HH).

This retrospective study analyzed medical records of patients who underwent 24-hour esophageal pH-impedance monitoring at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from November 2022 to December 2024. Eligible patients completed high-resolution manometry (HRM), upper gastrointestinal endoscopy, and enhanced CT scans of the upper abdomen/chest within six months of monitoring. Exclusion criteria included the presence of typical reflux symptoms, abnormal reflux parameters (acid exposure time >4% or DeMeester score >14.72), diagnosis of HH by endoscopy or imaging, abnormal HRM findings, previous diaphragmatic or HH surgery, and incomplete medical records. HSA and ESA were measured using multidetector computed tomography (MDCT) with multiplanar reconstruction technique, and the ESA/HSA ratio was calculated. An independent samples t-test was used to compare sex differences, and Pearson correlation analysis was used to assess the correlation between age and HSA/ESA. A two-tailed P<0.01 was considered statistically significant.

A total of 39 subjects were included, comprising 13 males (33.3%) and 26 females (66.7%), with a mean age of (52±14) years. HSA was (228.4±52.9) mm², ESA was (140.8±42.1) mm², and the ESA/HSA ratio was 0.61±0.10. No significant sex differences were observed in HSA [males (245.6±48.3)mm² vs females (222.5±54.1)mm²] or ESA [males (145.2±39.8) mm² vs females (135.4±43.5)mm²]. Age was not significantly correlated with HSA (r=0.306, P=0.059) or ESA (r=0.348, P=0.030).

This study reports for the first time the normal reference values for HSA and ESA and the ESA/HSA ratio in healthy adults. The ESA/HSA ratio demonstrates good stability and may serve as a novel morphological indicator for assessing the functional status of the esophageal hiatus, providing a reference for the accurate diagnosis of HH.

To investigate the feasibility of domestic robotic-assisted hiatal hernia repair combined with fundoplication in an animal model.

Two pigs were selected as experimental subjects and underwent robotic-assisted hiatal hernia repair in July 2024. Both Nissen (360°) and Toupet (270°) fundoplication were performed on each pig. The surgical time, blood loss, robot setup and teardown time were recorded for each procedure.

During the surgery, the animals’ vital signs were stable, and no serious complications such as massive bleeding occurred. The surgical time for Nissen fundoplication was 145.0 min and 151.6 min in pig A and pig B, respectively, and for Toupet fundoplication was 150.0 min and 168.4 min in pig A and pig B, respectively. The robot setup time was 10.0 min and 10.5 min, and the teardown time was 5.0 min and 5.5 min, respectively. The intraoperative blood loss was 52.0 ml and 56.7 ml, respectively. Both pigs successfully completed the surgery without any mortality during or after the procedure.

The preliminary application of domestic robot-assisted hiatal hernia repair combined with fundoplication in a porcine animal model shows that it is feasible and surgically safe, providing a reference for subsequent complex surgical procedures and large-sample training.

To investigate the impact of "Internet +" -based remote management on the negative emotional states, and quality of life in individuals with reflux esophagitis.

From September 2021 to September 2023, a total of 116 patients diagnosed with reflux esophagitis were enrolled in our study at our hospital. They were randomly assigned into two groups: routine management group (n=58) and remote management group (n=58). In the routine management group, patients followed their doctor’s advice regarding medication and dietary recommendations. On the other hand, patients in the remote management group received remote management services utilizing the "Internet +" approach. All patients were monitored and managed for a continuous period of 3 months. To compare the effectiveness of the two management approaches, we evaluated the general clinical characteristics (age, gender, body mass index, drinking history, smoking history, underlying diseases, duration of disease). Additionally, we assessed changes in negative emotions using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before and after management. Quality of life improvements were evaluated using the QOL-BREF scale, while sleep quality changes were assessed using the Pittsburgh Sleep Quality Index questionnaire (PSQI). Furthermore, compliance behavior was compared between the two groups using the Compliance Medication Behavior Scale (MMAS-8), among them, a score of 8 indicates good patient compliance, a score of 6 to 7 indicates moderate compliance, and a score of less than 6 indicates poor compliance. SAS, SDS, QOL-BREF and PSQI scores were compared by t-test, MMAS-8 scores were compared by Mann-Whitney U test, and the differences in patient compliance between the groups were compared using the χ² test.

After management, the SAS score (48.10±4.35) and SDS score (47.72±4.02) in the remote management group were significantly lower than those in the routine management group [(50.19±4.33), (49.26±4.06); t=2.588, 2.044; P=0.011, 0.043). The physical health score (18.53±2.19), mental health score (18.90±2.64) and total QOL-BREF score (77.12±4.54) in the remote management group were significantly higher than those in the routine management group [(16.10±2.33), (16.36±2.07), (72.40±4.75); t=5.795, 5.757, 5.472; all P<0.001]. The PSQI score in the remote management group (7.03±1.92) was significantly lower than that in the routine management group (8.72±1.50; t=5.288, P<0.001). The MMAS-8 score in the remote management group was higher than that in the routine management group [8 (4, 8) vs 6 (2, 8)], and the proportion of good adherence was higher than that in the routine management group (74.14% vs 51.72%), the differences are statistically significant (Z=2.422, χ²=6.379; P=0.015, 0.041).

The utilization of "Internet +" for remote management has proven to be beneficial to enhances patients suffering from reflux esophagitis mental well-being, sleep patterns, and overall quality of life. When compared to conventional management strategies, the remote management approach offered by "Internet +" exhibits the advantage of ensuring greater patient adherence.

To explore the safety, feasibility, and clinical efficacy and summarize the surgical experience of wrapping the residual stomach with the greater omentum in laparoscopic sleeve gastrectomy (LSG).

To retrospectively analyze the clinical data and follow-up results of 5 obese patients admitted to the department of hepatobiliary and pancreatic surgery of People’s Hospital of Bayinguoleng Mongol Autonomous Prefecture from May 2022 to February 2024 with 42 cases of obesity undergoing LSG by wrapping the stomach with the greater omentum, including two male and three female patients, aged 28-52 years old, with a BMI of 34.5-42.7 kg/m².

The five patients completed the surgery without intraoperative blood transfusion or transit. Open abdomen, operation time was 90-130 min, intraoperative bleeding was 20-50 ml, and postoperative hospitalization time was 4-6 days. After 12 months of follow-up, there were no complications such as postoperative bleeding, gastric leakage, gastroesophageal reflux disease (GERD), stenosis, and obstruction, and the patients were satisfied with the weight reduction efficacy of the surgery and postoperative rehabilitation.

It is safe, feasible, and clinically effective to wrap the residual stomach with the greater omentum during LSG, and the wrapping of the stomach with the greater omentum autologous tissue can effectively prevent the dilatation of the residual stomach and the occurrence of intra-thoracic sleeve migration, thus avoiding postoperative weight regain and the occurrence of GERD.

Obesity is a significant independent risk factor for hiatal hernia (HH), markedly increasing its prevalence. In recent years, with the rising volume of bariatric surgeries, the management of concomitant HH during these procedures has become a key clinical focus. Sleeve gastrectomy, as a mainstream bariatric procedure, combined concurrently with hiatal hernia repair (HHR), has emerged as an important strategy for treating obesity complicated with HH. Laparoscopic sleeve gastrectomy (LSG) combined with HHR is widely used and can effectively promote weight loss, provide anti-reflux benefits, and reduce the incidence of postoperative gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass combined with HHR demonstrates superior outcomes in weight reduction and GERD improvement, albeit with higher technical difficulty. Furthermore, novel techniques such as LSG combined with HHR with preservation of the anterior phrenoesophageal ligament have shown promising anti-reflux effects, although their long-term efficacy requires further validation. In conclusion, the surgical treatment of obesity with HH should involve an individualized selection of the surgical approach to achieve optimal therapeutic results.

Gastroesophageal reflux disease (GERD) is a common chronic upper gastrointestinal disorder, and its pathogenesis remains unclear. Recent studies suggest that the pathogenesis of GERD is closely related to structural and functional disorders of the lower esophageal sphincter anti-reflux barrier, abnormal clearance of refluxate in the esophagus, and reduced esophageal mucosal barrier function. With the increasing incidence of GERD in China, our understanding of it is also deepening. Research has shown that there is a close association between mental and psychological factors and GERD, which are mutually causal and influence each other. GERD patients with anxiety and depression have a lower quality of life than those with normal mental and psychological states. This article will review the research progress on the relationship between influencing factors such as anxiety, depression, and sleep disorders and GERD, as well as the related mechanisms and treatments.