Abstract: Clinical analysis of laparoscopic type Ⅲ、Ⅳ hiatal hernia repair        SHAO Xiang-yu，CHENG Tao，JI Zhen-ling，et al. Department of General Surgery，Affiliated Zhongda Hospital，Southeast University，Nanjing 210009，China
Correspondingauthor：LI Jun-sheng，E-mail：Lijunshenghd@126.com
Abstract    Objective    To analyze the outcomes of laparoscopic treatment of the largest hiatal hernias of type Ⅲ and Ⅳhiatal hernias. Methods    A total of 54 patients diagnosed with type Ⅲ and Ⅳ hiatal hernia were included，and repaired with laparoscopic procedure.Results    54 cases，including 33cases of type Ⅲ and 21 cases of type Ⅳ hiatal hernias successfully repaired with the laparoscopic procedure. The mean operation time was166.1±67.2min，and the medium postoperative hospital stay was 7d (4-42). There was no perioperative death. Two patient needed conversion，and all the others were completely laparoscopicly repaired. All  the patients` symptomswere improved after operation. There was no hernia recurrence during the follow-up period.Conclusion    Patients with type Ⅲ and Ⅳ hiatal hernias should be surgical treated earlier to avoid complications，and the minimally invasive technique combined with an anti-reflux procedure was safe for these patients.

Key words: hiatal hernia, laparoscopic repair, mesh, fundoplication

摘要： 目的    分析腹腔镜手术治疗Ⅲ、Ⅳ型食管裂孔疝的方法和疗效。方法    回顾性分析2014年1月至2021年1月东南大学附属中大医院普外科收治的54例行腹腔镜手术治疗的Ⅲ、Ⅳ型食管裂孔疝病人的临床资料，手术方式为食管裂孔疝修补术+胃底折叠术。随访观察术后疗效及并发症发生情况。结果    Ⅲ、Ⅳ型食管裂孔疝54例，包括Ⅲ型食管裂孔疝33例，Ⅳ型21例。手术时间为（166.1±67.2）min，术后中位住院时间为7（4~42）d。无围手术期死亡，中转开放手术2例。所有病人术后症状明显改善。随访46（8~80）个月，无疝复发。结论    对于Ⅲ型和Ⅳ型食管裂孔疝病人，建议早期行腹腔镜食管裂孔疝修补术及胃底折叠术治疗，以减少并发症发生。

关键词: 食管裂孔疝, 腹腔镜修补术, 补片, 胃底折叠