Obstract　To investigate the short-term clinical outcome of Stretta radiofrequency for patients with refractory nonerosive reflux disease (NERD).

Fifty patients with refractory NERD underwent Stretta procedure were enrolled. They were followed-up for six months after Stretta procedure. The symptom control, quality of life, satisfaction rate, lower esophageal sphincter (LES) pressure, 24-hour pH and proton pump inhibitor (PPI) usage were evaluated. The complications were assessed. The outcomes of the 6-months follow-up results were analyzed and compared with the baseline data.

Stretta procedure was succeed in all 50 patients. No severe adverse events or complications occurred. Forty-eight patients finished the 6-month follow-up, Stretta was effective in both reducing total symptom scores (from 17.0±5.3 to 6.4±3.9, t=12.332, P=0.000) and improving quality of life scores (from 546.6±149.8 to 607.4±143.5, t=-3.479, P=0.002). Forty-five patients (94%) were satisfied with the intervention. LES pressure increased significantly (from 9.9±4.3 mmHg to 14.4±4.6 mmHg, t=-5.541, P=0.000). Regarding 24-hour pH monitoring, reflux episodes (62 vs. 30, Z=-5.565, P=0.000), pathological acid exposure (8.3% vs. 4.4%, Z=-5.583, P=0.000) and DeMeester score (28.7 vs.13.0, Z=-5.733, P=0.000) were improved significantly compared to the baseline (P=0.000). 62% patients with mild pathological acid reflux and 22% with moderate pathological acid reflux achieved normal esophageal acid exposure. At the 6-month follow-up, complete PPI cessation was achieved in 42 patients (88%), 5 patients (10%) took PPI on-demand while 1 patient (2%) took PPI as much as before the Stretta procedure. Two patients who cannot stop PPI underwent Laparoscopic Nissen fundoplication and achieved symptom control and PPI cessation, too.

The Stretta procedure was safe and effective in the short term for the management of NERD. It can improve LES pressure as well as 24-hour pH metrics, especially for mild reflux patients, and achieved improvement of symptom control and PPI cessation in the short term follow up. Fundoplication is feasible and effective after failed Stretta procedure.

Spinal abnormalities and hiatal hernias are becoming more common in our aging population. Increasing evidence has shown that the presence of kyphoscoliosis would increase hiatal hernia formation. Kyphoscoliosis has been shown to lead to decreased quality of life, poor pulmonary function, and restrict abdominal compliance. All of these factors have the potential to increase morbidity and mortality associated with the surgical repair of hiatal abnormalities. In the present we reported two cases of hiatal hernias repair in kyphoscoliosis patients, with a prolonged duration of malnutrition due to inability to eat, and received nasogastric tube feeding or total parenteral nutrition (TPN). Operative planning and subsequent hiatal hernia repair must be undertaken in the context of these spinal abnormalities.

To explore the feasibility, clinical application value and safety of laparoscopic surgery in treating patients with esophageal hiatal hernia.

The clinical data of 20 cases of esophageal hiatal hernia who were enrolled to undertake laparoscopic hiatal hernia repair and fundoplication at our hospital were retrospectively analyzed from March 2012 to September 2017, then we value their clinical results and prognosis.

All 20 cases of laparoscopic operations were accomplished successfully and no conversions were needed, including 16 cases of Nissen operation, 4 cases of Toupet operation,20 cases of hernia repaired with non-absorbable suture, 7 cases repaired with U Soft Mesh.Mean operation time was 150 minutes (range: 95~180 minutes). Mean intraoperative blood lose was 40ml (range: 30~70 ml).Liquid diets were taken in after 24~48 hours of surgery. Clinical symptoms were effectively relieved in all cases and no mortality and severe complications were noted. Mean postoperative hospital stay were 4.1 days (range: 3~7days). 20 cases were all followed up, and mean follow up period was 2.6 years (range: 3 months to 5 years), there were no cases who dead and with anatomic recurrence, the rate of satisfaction for operation was 95.0%.

Minimally invasive laparoscopic surgery for esophageal hiatal hernia has the obviously advantages of minimal trauma, fast recovery, safe, high reliability and generalizable value.

To explore the clinical features, treatment and prognosis of neonatal congenital intestinal malrotation.

From December 2008 to December 2017, 65 patients were treated for malrotation of intestine in People′s Hospital of Xinjiang Uygur Autonomous Region pediatric surgery.65 cases, of children surgical age is 2days to 28 days(the mean operative age was 7±1.2 days). All children were confirmed as congenital intestinal malrotation by intraoperative or preoperative auxiliary examination.Sixty patients developed intermittent vomiting with gastroesophageal reflux after birth.55 patients were intermittent biliary vomiting.Five patients showed hematochezia.All children underwent color Doppler examination before surgery.There were 45 cases of positive.60 patients completed digestive angiography before surgery.There were 92% of positive.Sixty-five patients underwent Ladd′s surgery.

Sixty-five patients confirmed congenital intestinal malrotation during surgery.There are 5 patients with midgut torsion.2 cases had intestinal torsion and intestinal necrosis, accepted intestinal resection of intestinal anastomosis.One patient had congenital chylomicrons.Twenty patients combined with other gastrointestinal malformations.Intestinal torsion in children with clinical features are bloody stools, meningitis signs.

Intermittent vomiting with gastroesophageal reflux is the main manifestation of congenital intestinal malrotation.Bloody stool with peritonitis signs is a clear indication of emergency surgery.Gastrointestinal imaging is more accurate than color Doppler.Neonatal congenital intestinal malrotation complete Ladd surgery in time.Surgical effect is good, the prognosis is good.

Parahiatal diaphragmatic hernias are rare entities.We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh.The current report is intended to depict the clinical profile, the diagnosis and treatment of this rare disease.A 73-year-old woman presented to us.CT scan showed a paraesophageal hernia with intrathoracic stomach.During the laparoscopic approach, A diagnosis of parahiatla hernia was made, which was distinct from the esophageal hiatal hernias.The hernia sac was large and the adhesion was intense.A laparoscopic mesh repair was performed with a composite mesh and Dor procedure.Parahiatal hernia has a low incidence rate, and prone to sever complications, usually can not be distinguished from esophageal hernia prior to operation.Laparoscopic repair of parahiatal hernia is feasible mini-invasive and safe.

To explore the clinical efficacy of laparoscopic hiatal hernia repair in combination of fundoplication in treating patients with reflux esophagitis and hiatal hernia.

Retrospective analysis ofthe clinical data of 54 patients with reflux esophagitis and hiatal hernia under laparoscopic hiatal hernia repair in combination of fundoplication admitted from January 2012 to January 2016.In aspects of the operation time, intraoperative blood loss, postoperative hospitalization days and complications to evaluate the treatment effect of laparoscopic hiatal hernia repair combined fundoplication.

There were 53(98%)patients underwent the laparoscopic hiatal hernia repair and fundoplication.One case converted tolaparotomy.47(87%)patients used mesh repair while others did not.The number of patients who did the operation of Toupet, Nissen, Dor(gastric folding degree were 270°, 360°, 180°respectively)were 32(59.3%), 19(35.2%)and 3(5.5%). Operation time was 95~355 minutes, average time(193.6±87.6)minutes.Intra-operative blood loss was 10~600 ml, average blood loss(72.5±21.3)ml; the average postoperative hospitalization stay was(8.1±7.4)days, 53 patients′postoperative hospitalization stay were 3~18 days, one was 62 days.The extubation time was 3 days after operation.The complication included: One case with digestive fistula(Nissen), who recovered in 10 days after the continuous gastrointestinal decompression and peritoneal drainage.One case had the symptom of difficulty swallowing and 2 cases(Toupet)with sickness and reflux, with conservative treatment, they recovered in 1 week.In 3 years following up, 12 patients lost access and 42 patients had complete remission.

For reflux esophagitis and hiatal hernia patients, laparoscopic hiatal hernia repair and fundoplication is a safe and effective treatment method.

To investigate the efficacy of Argon plasma coagulation(APC)combined with esomeprazole enteric-coated tablets in the treatment of Barrett′s esophagus.

The clinical data of 284 patients with endoscopy and diagnosed BE were analyzed retrospectively from January 2015 to January 2016 in Xinjiang Uygur AutonomousRegion People′s Hospital.Among them, 78 patients were treated with estradiol enteric(group A); 206 patients underwent APC combined with estradiol enteric-coated tablets(group B). Compared the clinical efficacy between the two groups before and after treatment.

The BE mucosa of group A was not significantly reduced while it was disappeared in 97.57% patients in group B.

APC combined with esomeprazole enteric-coated tablets is a simple, safe and reliable method for the treatment of esophageal mucosa in patients with BE lesions.It can not only improve the symptoms of BE, but also can cure the BE lesions, which is worthy of clinical application.

To evaluate the efficacy of laparoscopic hiatal hernia repair in the treatment of hiatal hernia presents with iron deficiency anemia.

26 cases of hiatal hernia present with iron deficiency anemia from June 2006 to February 2014 were retrospectively analyzed, and reexamined the blood routine examination in postoperative regular follow-up to observe the anemic correction.

26 cases of hiatal hernia present with iron deficiency anemia successfully underwent laparoscopic hiatal hernia repair without conversion of laparotomy.All of the 26 patients′anemia were corrected based on the results of reexamined blood routine examination during postoperative follow-up.Respective preoperative and postoperative test result were(82.73±14.04), (120.88±8.94)(P<0.01).

Hiatal hernia is one of the causes of iron deficiency anemia, and it′s effective to utilize laparoscopic haital hernia repair in the treatment of hiatal hernia presents with iron deficiency anemia.

To investigate the application of three-dimensional laparoscopic paraesophageal hernia repair.

There were 8 patients from November 2014 to February 2015 underwent three-dimensional laparoscopic repair of hiatal hernia, 5 cases of them repaired with mesh and 3 cases of them without mesh.

All operation succeeded.The mean time of operation was(110±18)minutes, average intraoperative bleeding was(28±13)ml, the mean postoperative time of liquid intake was(2.0±0.3)days, the mean postoperative hospital stay was(8.9±2.5)days.No serious postoperative complications occurred.The clinical symptoms disappeared in one month after operation, and no recurrence occurred.

The three-dimensional laparoscopic paraesophageal hernia repair may be performed safely and effectively with decreased surgical difficulties.

Evaluate the clinical effects and feasibility of hiatal hernia and gastroesophageal by laparoscopic in primary hospital.

Form March 2009 to December 2014, 10 cases of hiatal hernia and gastroesophageal in Yanqi people′s Hospital, all the patients was done Nissen fundoplication and 7cases underwent patch repair for hiatal hernia.

10 cases all be done by laparoscopic, no one conversion to laparotomy.The operation time was 113 min, blood loss were 45.5ml, mean postoperative hospital stay were 7.6 days.Esophagitis and esophageal ulceration cured were observed by gastroscope after operation at first month and sixth month, With the follow-up of 11 to 18 months, 10 cases no recurrence and no gastroesophageal.

Nissen fundoplication and patch repair by laparoscopic is a safe and reliable treatment for hiatal hernia and gastroesophageal, The primary hospital with laparoscopic equipment facility and experience of conversion to laparotomy can do this treatment, it can product remarkable long-term clinical and social effects.

The aim of the present study was to evaluate the safety and efficacy of laparoscopic repair of esophageal hiatal hernia at our hospital.

Between August 2010 and August 2014, 56 patients at our department underwent laparoscopic repair and Nissen fundoplication of esophageal hiatal hernia, the clinical data from these cases were retrospectively analyzed.

The mean operation time was(117.4±39.9)minutes, intraoperative blood loss was(47.3±21.8)ml, the time to first flatus was(35.7±13.9)hours and the time of postoperative hospital stay was(5.4±2.2)days.There were statistically significant reductions(P<0.005)in visual analog scores(VAS)for all post-operative time points(1month and 6 months postoperatively). All cases were followed up, no hernia recurrence was found.

Laparoscopic repair and Nissen fundoplication is a technically safe and feasible surgical procedure for the treatment of esophageal hiatal hernia.

To investigate the efficacy and safety of laparoseopic repair of paraesophageal hernia and ganstroesophageal reflux disease.

21 patients underwent laparoscopic repair of paraesophageal hernia, including 13 cases having laparoscopic Toupet fundoplication And 8 cases having laparoscopic Nissen fundoplication.

Laparoscopicrepair of paraesophageal Hernia and Laparoscopic fundoplication was completed successfully in all 21 patients.The average operation time 118min and the blood loss Was between 30~70 ml.Postoperative oral feedings were resumed after 24~48 h of surgery.The median postoperative hospital stay Was 6.5 days.

Laparoscopic repair of paraesophageal hernia and Laparoscopic fundoplication is an effective and safe surgcal procedure of minimal invasion for Paraesophageal hernia.