Surgical treatment of hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors

Abstract

Objective To investigate the perioperative management and safety of the patients who had hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors. Methods Statistics the medical record information of 17 patients who had hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors in Xinjiang Uygur Autonomous Region People′s Hospital from October 2012 to January 2015.All of them were adopted laparoscopic minimally invasive surgery, 13 cases were adopted pure hiatal hernia suture, 3 cases were used biological patch repair, 1 case used Johnson PHY patch repair.In anti reflux surgery there were 8 patients underwent Nissen fundoplication, 6 cases underwent Dor fundoplicationand and 3 cases underwent Toupet fundoplication.Pathology results suggest that among very low risk of gastric stromal tumor in 8 cases, low risk in 4 cases, 3 cases of moderate risk, 1 case of high risk and 1 case of very high risk, Retrospectively analyzed these patients perioperative treatment measures. Results This group of patients has no perioperative death, no serious postoperative complications.The reflux symptoms were significantly improved postoperative, There is significantly lower than the preoperative in reflux time, the number of reflux, acid reflux time percentage, long reflux episodes and DeMeester score(P<0.05). GERD Q scale score was significantly lower than the preoperative(P<0.05). LES pressure significantly increased compared with preoperative(P<0.05). There were 1 patient had wound infection postoperative, 1 patient had chronic pain, both of them recovered after administering medication and physiotherapy.2 patients had postoperative eating choked, 1 patient suffered from diarrheathe, symptoms disappeared after 1 month by nursing them smaller meals and eat slowly.The hemoglobin in the patients combined preoperative anemic recovered to 95 g/L after the surgery.None of them recurred after 10 months′follow-up. Conclusion The surgery risky was high and the operative would be more difficult with the complex condition which the patients had hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors.However, it is still safe and feasible with adequate preoperative preparation, appropriate surgical methods, careful and meticulous operation and targeted treatment of postoperative various problems. Key words: Hernia, hiatal; Gastroesophageal reflux; Gastrointestinal stromal tumors; surgical