A novel surgical approach for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach

Abstract BackgroundAlthough the traditional bilateral surgical approach can provide local protection of the vagus nerve, the integrity of the entire vagus nerve cannot be evaluated. Therefore, we developed total left-side surgical approach (TLSA), which theoretically eliminates injury to the vagus nerve, and evaluated its safety and effectiveness.MethodsWe initially performed a cadaver study to explore the characteristics of the vagus nerve, and then prospectively evaluated the TLSA in 5 patients with hiatal hernia and gastroesophageal reflux disease between June 2020 and September 2020. Demographic characteristics, surgical parameters, perioperative outcomes, and follow-up findings were analyzed.ResultsThe patients were 40–64 years old and all 5 patients underwent TLSA successfully without any major complications. The median total operative time was 114 min, the median blood loss was 50 mL, and the median postoperative hospital stay was 3.8 days. Gastrointestinal function recovered within 4 days in all patients. The 6-month follow-up gastroscopy examination revealed well-established gastroesophageal flap valves. Relative to the baseline results, the 6-month follow-up revealed lower values for the total GerdQ score (12.4 vs. 6.2) and the total esophageal acid exposure time (3.48% vs. 0.38%). Based on the EORTC QLQ-STO52 questionnaire results, the incidences of dysphagia and flatulence decreased over time after the procedure.ConclusionsTLSA provides a clear and broad surgical field, less trauma, rapid recovery, and is technically simple. Although our results suggest that the TLSA provides good safety and short-term efficacy, long-term results from a larger clinical trial are needed to validate these findings.Trial registrationChiCTR2000034028, registration date is June 21, 2020.