关键词: 食管裂孔疝, 抗反流手术, 补片, 肥胖

Abstract: Further understanding the specificity of treatment for hiatal hernia        TANG Jian-xiong,LI Shao-jie. Department of General Surgery & Hernia and Abdominal Wall Diseases Treatment Center, Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China
Correspongding author:TANG Jian-xiong,E-mail:johnxiong@
china.com
Abstract    Hiatal hernia (HH) is a special type of hernia. Although it shares structural similarities with other hernia diseases,its specificity is more reflected in clinical diagnosis and treatment,and many problems need to be explored and solved. Firstly, the diagnosis of HH should not only focus on distinguishing symptoms, but also comprehensively consider the results of gastroscopy, GI, CT, and high-resolution esophageal pressure and acid measurement; Secondly, HH is a common cause of GERD, but mechanical repair of esophageal hiatus alone often cannot achieve the effect of improving symptoms, so anti-reflux surgery is widely recognized. Laparoscopic HH repair surgery has been widely accepted nowadays,and traditional and some innovative fundoplication techniques have achieved good therapeutic effects. However,although da Vinci robotic surgery has certain technical advantages,it is still not widely carried out in China due to high cost. The debate over HH repair materials has always existed. For patients with large defects and weak diaphragmatic muscles, it is recommended to use meshes for hernia repair,but it should not be too large and requires conformal cutting,Synthetic materials and biological materials have their own advantages and disadvantages,which should be chosen according to discretion. There are many obese patients with concomitant HH,and their treatment is more complex. The combination of HH repair and weight loss surgery is widely accepted,and more clinical evidence is needed to verify it.

Key words: hiatal hernia, anti-reflux surgery, mesh, obesity