In December 2022, the American Society of Gastrointestinal and Endoscopic Surgeons and other multi-society societies released the Multi-Society Consensus Conference and Guideline for the Treatment of gastroesophageal reflux disease (2022), which explores standardized procedures for evaluation, diagnosis, and treatment of patients with gastroesophageal reflux disease around four key questions. It has an important guiding effect on the diagnosis and treatment gastroesophageal reflux disease patients in clinical settings. This article interprets the consensus guideline to help physicians understand the consensus guideline.
To evaluate the therapeutic efficacy of applying the "Four-in-One" concept in the repair of hiatal hernia and fundoplication surgery.
Methods
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.
Results
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.
Conclusion
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.
To study the effectiveness and safety of biological mesh in laparoscopic hiatal hernia repair.
Methods
Prospectively collect clinical data of 60 patients with hiatal hernia combined with gastroesophageal reflux disease who were seen at the Department of Hernia and Abdominal Wall Surgery of the Affiliated Zhongda Hospital of Southeast University from Jan. 1, 2022, to Sept. 30, 2023, and follow up the patients, all of whom were treated by laparoscopic hiatal hernia repair and biological mesh was applied during the operation, respectively. All patients underwent laparoscopic hiatal hernia repair with gastric fundoplication and intraoperative reinforcement of the diaphragm with a biological mesh, and the patients were followed up at the 1st, 3rd and 6th months after the operation, including acid reflux, heartburn, vomiting, chest pain, Overall satisfaction, recurrence and mesh-related complications and comparing the preoperative and postoperative indexes.
Results
All patients successfully completed the surgery without intermediate openings, the mean preoperative age of the patients was (61.85±15.83) years, the mean body mass index was (24.44±3.65) kg/m2, the mean operative time was (125.83±45.67) min, the mean hernia width was (3.10±1.27) cm, sliding hiatal hernia was 31(51.67%) cases, the total hospitalization time was (9.44±3.32) d, and the mean postoperative follow-up was (10.68±6.15) months, the completion rate of postoperative follow-up was 100% at 1 month after the operation, the completion rate of postoperative follow-up was 98.33% at 3 months after the operation, and the completion rate of postoperative follow-up was 78.33% at 6 months after the operation, and the patients' postoperative symptoms of acid reflux and heartburn improved significantly compared with the preoperative ones, All of them improved significantly compared with the preoperative period. The overall satisfaction score of the patients before surgery was median 3 (2-4), and the overall satisfaction score of the patients at 6 months after surgery was median 10 (9-10), Overall postoperative satisfaction was significantly higher and the difference was statistically significant (P<0.05), a total of 3 patients had recurrence, including 1 patient with symptomatic plus radiographic recurrence, and no patient had mesh-related complications.
Conclusion
The use of biological mesh in laparoscopic hiatal hernia repair was effective and safe, with no mesh-related complications and high overall patient satisfaction during the follow-up period, which, of course, needs to be longer.
To investigate the efficacy of acid suppression and pulmonary function in patients with asthma combined with acid reflux after clinical treatment with esomeprazole in combination with mosapride.
Method
Patients with asthma combined with GERD (51 cases) hospitalized in the Respiratory and Critical Care Medicine Center of the People's Hospital of Xinjiang Uygur Autonomous Region from June 2020 to December 2021 were retrospectively analyzed and further divided into a control group (given conventional asthma treatment) and a study group (given esomeprazole combined with mosapride citrate on top of the control group) according to the treatment modality. General clinical information, lung function, GERDQ scale, asthma control test (ACT) score and Medical research association dyspnea scale (mMRC) were collected. Patients in both groups were treated for 8 weeks, and the improvement of the above indicators was collected and analyzed before and after treatment in both groups.
Result
The improvement of acid reflux symptoms (GERD-Q) score, ACT score, and mMRC score indicators in the research group was significantly better than that in the control group, and the differences were statistically significant (P<0.05). Two groups of patients underwent pulmonary function analysis before and after treatment, and it was found that compared with the control group, the study group significantly improved lung function indicators: first second forced expiratory volume/forced vital capacity (FEV1/FVC), oxygen partial pressure, and carbon dioxide partial pressure. The differences were statistically significant (P<0.05). The total effective rate of the control group was 64.00%, while that of the study group was 88.46%, with a statistically significant difference (P<0.05).
Conclusion
The use of esomeprazole combined with mosapride citrate in the treatment of asthma combined with GERD is more effective than conventional treatment and deserves further clinical application.
Exploring the application and role of group teaching and training in improving research abilities of medical professional graduate students.
Methods
A total of 23 graduate students of minimally invasive surgery major whom received standardized training in the People's Hospital of Xinjiang Uygur Autonomous Region from September 2017 to July 2021 were selected and randomly divided into the control group (12 students) and the control group (11 students) using the numerical table method; Traditional teaching and group teaching are adopted respectively. Through theoretical examination, practical application (including literature retrieval and statistical software) and questionnaire survey, the teaching effect of the two groups was compared and analyzed.
Results
The excellent and qualified rate of theoretical examination and practical operation ability of the students in the study group was markedly high as compare to control group (P<0.05); The students in the research group showed a higher degree of interest in the group teaching and research improvement ability course, inspiration for scientific research thinking and satisfaction with teaching methods (P<0.05), suggesting that the students were more interested in scientific research and effectively improved their scientific research innovation thinking.
Conclusion
Compared with traditional teaching, group teaching can improve students' interest in scientific research and better cultivate their innovative ability in scientific research.
Hiatal hernia is a common surgical disease, and obesity is one of the independent risk factors for hiatal hernia. However, the mechanism by which obesity promotes the occurrence of hiatal hernia is still unclear. With better recognition regarding the relationship between obesity and hiatal hernia, as well as with the clinical symptoms, examinations, and intraoperative exploration, we can improve the diagnostic ability of hiatal hernia complicated with obesity. In addition, individualized evaluation of hiatal hernia according to the patient's obesity classification are of great significance for selecting the appropriate surgical treatment plan. In this article, we aim to discuss the diagnosis and treatment of hiatal hernia complicated with obesity with regards to the diagnostic timing and surgical methods.
Esophageal hiatal hernia occurs when an abdominal structure, aside from the esophagus, protrudes into the thoracic cavity via an enlarged esophageal hiatus, and patients commonly experience frequent acid reflux, heartburn, retrosternal pain, and other discomfort. The rising prevalence of this disease within the population has necessitated more comprehensive research into the ailment and the development of optimized and standardized treatment protocols. Given that clinical trials may not fully address certain research needs, animal experiments can complement these limitations. Therefore, the inclusion of animal models in hiatal hernia research is imperative, with the porcine hiatal hernia model emerging as an ideal choice due to its unique advantages. Laparoscopic repair of esophageal hiatal hernias and the use of meshes and fixation devices have become the predominant treatment approach. The porcine esophageal hiatal hernia model offers a reproducible platform for training young surgeons in laparoscopic procedures and serves as robust evidence for validating the safety and efficacy of new meshes and fixation devices. Additionally, porcine animal models have found extensive use in exploring changes in biological behavior at the hiatus postoperatively and in innovating surgical techniques for esophageal hiatal hernia repair, including the application of robotic surgery. This article provides a comprehensive review through a literature survey on the establishment of a porcine esophageal hiatal hernia model and its applications and research advances in this field.
Sleeve gastrectomy is a common type of metabolic surgery, with one of its common complications being gastroesophageal reflux. Gastroesophageal reflux disease brings about discomfort symptoms such as coughing, asthma, chronic laryngitis, and dental caries, leading to a significant negative impact on patients' lives and health. This review aims to summarize the corrective surgical options required for different types of post-sleeve gastrectomy gastroesophageal reflux disease. Through comprehensive analysis of relevant literature, we found that Roux-en-Y gastric bypass surgery holds an important position in the treatment of post-sleeve gastrectomy gastroesophageal reflux. Additionally, emerging surgical treatment options such as the LINX anti-reflux system also show potential. However, the evaluation and standardization of treatment effects, management and prevention of postoperative complications, and the development of personalized treatments remain challenges. Future research should focus on addressing these issues and further explore new directions and innovative methods for the treatment of post-sleeve gastrectomy gastroesophageal reflux.
Gastroesophageal reflux disease (GERD) is considered one of the most common chronic gastrointestinal diseases worldwide, and GERD is a common disease in adults and children. The global prevalence of GERD is high and increasing. Non erosive reflux disease is the most common phenotype of GERD. Heartburn and reflux are considered typical symptoms, but gastroesophageal reflux may manifest as various atypical and extraesophageal manifestations. The pathophysiology of GERD is multifactorial, and different mechanisms may lead to symptoms of GERD, including gastric motility, anti reflux barrier, reflux characteristics, clearance mechanisms, mucosal integrity, and obesity. In the esophageal mucosa, there are various inflammatory factors, immune mediators, transcriptional mediators, and markers of epithelial differentiation and integrity that are overexpressed or underexpressed in esophagitis, providing many candidates for biomarkers with diagnostic or prognostic potential. A clear mechanism of inflammatory factors has high clinical application value in the treatment of GERD induced esophageal mucosal inflammation. This article discusses the research progress of some important and key factors mediating esophageal mucosal inflammatory damage in GERD disease.
To explore the clinical application value of continuous nursing based on WeChat platform in self-management of obese patients with gastroesophageal reflux disease after operation.
Methods
A total of 115 obese patients with gastroesophageal reflux disease who were hospitalized in the Department of minimally invasive, hernia and abdominal wall surgery and underwent sleeve gastrectomy combined with fundoplication in the People's Hospital of Xinjiang Uyghur Autonomous Region from October 2021 to March 2023 were selected and randomly divided into control group (n=40) and test group (n=75). In which, the control group was discharged with routine postoperative diet, medication and telephone follow-up, while the test group was given a continuing nursing service using wechat platform on the basis of the control group. Postoperative self-management was compared between the two groups. Multivariate logistic regression was used to analyze the risk factors for readmission within 1 month after sleeve gastrectomy combined with fundoplication.
Results
One month after operation, it was found that the unplanned readmission within one month after operation(9.3% vs 27.5%, P=0.011) and unplanned readmission due to vomiting(8.0% vs 22.5%, P=0.028) and hypokalemia(9.3% vs 25.0%, P=0.024) were lower than those in the control group. Univariate and multivariate Logistic regression analysis showed that the risk factor of unplanned readmission within one month after operation was the lack of continuous nursing based on WeChat platform (P<0.05).
Conclusion
Continuous nursing based on Wechat platform has certain clinical application value in self-management of patients after sleeve gastrectomy combined with fundoplication.
