In 2004, our department started to apply thoracoscopy for the surgical treatment of esophageal smooth muscle tumor, and in 2005, we started laparoscopic treatment of esophageal hiatal hernia and cardia achalasia. Especially in recent years, the intraoperative esophageal manometry guided laparoscopic esophageal hiatal hernia and cardia achalasia surgery under the leadership and guidance of Director Li Jianye has improved the surgical techniques for benign lower esophageal diseases, ensured the surgical results and reduced postoperative complications, and also made an important contribution to the research on the surgical mechanism of benign lower esophageal diseases. Laparoscopic technique for the treatment of hiatal hernia of esophagus has the advantages of less trauma, faster recovery, positive anti-reflux effect, less complications and easy acceptance by patients. Laparoscopic treatment of GERD has been widely carried out in foreign countries, and rich clinical experience has been accumulated. In recent years, it has been reported in various parts of China, but the total number of cases is only one hundred. In our hospital, only one case of laparoscopic anti-reflux surgery was transferred to open surgery due to technical problems and intraoperative pneumothorax, but the rest of the cases were operated successfully and the reflux symptoms disappeared after surgery. Our experience is that the indications for laparoscopic treatment are basically the same as those for transabdominal surgery for common esophageal hiatal hernia. In terms of technical operation, trans-laparoscopic anti-reflux surgery is not difficult for those who are proficient in laparoscopic technique, which is significantly better than trans-abdominal surgery in revealing and suturing the esophageal hiatus. The choice of anti-reflux procedure for trans-laparoscopic surgery is inconclusive as to which is the better outcome. A typical Nissen procedure with too long a gastric fold wrap tends to cause gastric ulcers due to poor drainage of acid within the folded gastric folds. In addition, the gastric fold suture is so blind that even a very experienced surgeon cannot completely prevent the patient from having difficulty swallowing after surgery due to the tight suture; the postoperative anti-reflux effect of the short-loose Nissen procedure is basically the same as that of the typical Nissen procedure. Intraoperatively, the lower thoracic segment of the esophagus is separated upward as much as possible through the esophageal fissure, and the esophagus is pulled downward while bluntly separated in order to restore and lengthen the abdominal segment of the esophagus. The two stitches of the gastric fold 360b suture fixed in the esophageal wall must be positioned high so as to effectively ensure the length of the abdominal segment of the esophagus after surgery. This short-loose Nissen operation is simple, with good anti-reflux effect and fewer postoperative obstructive complications than typical Nissen operation; some domestic scholars believe that the choice of Toupet’s gastric fundoplication suture of 180 degrees can avoid the occurrence of postoperative dysphagia and air-topping syndrome. However, this procedure requires sutures on both sides of the esophagus and more stitches (at least 6 stitches); we found in the long-term follow-up that patients with esophageal cardia fixation have more definite immediate and long-term postoperative results, especially Boerema (gastric lesser curvature with anterior abdominal wall fixation) and Rampal (gastric fixation with hepatic round ligament), which are simple to operate and have more ideal anti-reflux effect. The main problem of laparoscopic surgery for GERD in China is that thoracic surgeons have not yet mastered laparoscopic operation techniques, while general surgeons do not know much about the mechanism of GERD and anti-reflux surgery and the anatomical relationship between the esophageal foramen and the cardia. How to solve this problem is the key to whether laparoscopic surgery can be widely performed. Appendix: benign diseases of the lower esophagus Cardia achalasia, reflux esophagitis, esophageal hiatal hernia and other functional esophageal diseases are benign diseases of the lower esophagus, which are common diseases affecting people’s health. In China, there is less research in this area. Achalasia is the lack of peristalsis in the body of the esophagus during swallowing action, and the relaxation of the lower esophageal sphincter (LES) is impaired, resulting in the retention of food and gradually causing the dilatation of the esophagus. Cardia is a disease that requires surgical treatment second only to esophageal cancer. The epidemiological study of this disease, the incidence rate reported abroad is 0.5-8/100,000, and the incidence rate reported in China is about 0.5-1.0/100,000. There are many surgical methods for the treatment of cardia achalasia, among which the most widely used is esophageal myotomy (modified Heller procedure). The modified Heller procedure has excellent efficacy of 85-90%, but there are still certain complications. The common complications include reflux esophagitis, postoperative dysphagia, esophageal mucosal perforation, mucosal diverticulum of the lower esophagus and esophageal hiatal hernia. The incidence of postoperative reflux esophagitis and dysphagia is higher. Most of the literature reports the incidence of reflux esophagitis in 10-30% after modified Heller procedure. The causes of reflux esophagitis are as follows: 1) destruction of the normal anti-reflux structures by incision of the lower esophageal sphincter; 2) damage to the gastric ligament fibers by vertical incision of the fundus along the longitudinal axis of the esophagus; 3) damage to the vagus nerve and impaired gastric emptying after surgery, increasing the incidence of reflux esophagitis; 4) damage to the esophageal hiatal structures during surgery and postoperative esophageal hiatal hernia. To reduce or alleviate the occurrence of postoperative reflux esophagitis, some operators add anti-reflux surgery to the Heller procedure. The incidence of dysphagia after modified Heller surgery also ranges from 3-5%. the main cause of dysphagia after Heller surgery is: incomplete sphincterotomy. Esophageal hiatal hernia is also a common gastrointestinal disease with a certain difference in incidence at home and abroad. Autopsy data from western countries found that 30% of people over 40 years of age had esophageal hiatal hernia, while in China the disease accounts for 5%-20% of patients seen for gastrointestinal symptoms, and its incidence increases with age. Esophageal hiatus hernia has the potential for gastroesophageal reflux, which can cause corresponding respiratory and other systemic diseases. Studies have found that esophageal hiatal hernia is not only dangerous for patients, but it has been shown to be a risk factor for esophageal malignancy along with gastroesophageal reflux and Barrett’s esophagus. In recent years, the incidence of reflux esophagitis in China is on the rise, and according to the survey statistics in Beijing and Shanghai, the incidence of reflux esophagitis is about 2%. The basic pathogenesis is mainly the decrease of anti-reflux defense mechanism and the damage to esophageal mucosa by reflux material. The function of the LES plays an important role in the anti-reflux barrier, and the indicators reflecting the function of the LES are mainly the lower esophageal sphincter pressure (LESP) and the total length of the lower esophageal sphincter (LESL). The main clinical manifestations are acid reflux, heartburn, chest pain and dysphagia, and some of them can also cause chronic pharyngitis, asthma, otitis media, sinusitis, aspiration pneumonia and many other diseases. With medication, most patients get relief from their symptoms. However, some severe patients often require surgical treatment. Especially in recent years, with the improvement of people’s quality of life and minimally invasive surgery, more and more patients want to be relieved of their pain by surgical means. In the past, esophageal hiatal hernia and reflux esophagitis were considered as one and the same. In recent years, it has been found that more than half of the patients with esophageal hiatal hernia develop reflux esophagitis, while about 60% of reflux esophagitis have esophageal hiatal hernia. However, once the two occur together, they often aggravate each other. Therefore, an anatomically significant repair of esophageal hiatal hernia is performed in conjunction with anti-reflux surgery. Although there are various types of anti-reflux surgery, the basic principle is the same: by increasing the length of the intra-abdominal esophagus and folding the gastric fundus, the LES pressure is raised and a live flap is formed at the cardia, allowing food to pass in one direction. The key to successful surgery lies in the fundic fold. Postoperative acid reflux and dysphagia are mostly related to the tightness of the fundoplication suture. The LESP should be adjusted and the LESL should be considered during the anti-reflux fundoplication surgery. In conclusion, the development of reflux esophagitis, esophageal hiatus hernia, and cardia achalasia are all related to the abnormal pressure and length of the lower esophageal sphincter and the repair of the esophageal hiatus, and the outcome of surgical treatment is directly related to the degree of lower esophageal sphincter dissection, the tightness of the fundoplication, and the repair of the esophageal hiatus. The degree of lower esophageal sphincter dissection and the tightness of the fundic fold suture and esophageal foramen repair have been judged by experience, which is often insufficient to avoid complications such as postoperative reflux and dysphagia. Previous scholars have applied 46-50 FMaloney probes or cervical probes intraoperatively to solve the problem of fundic fold tightness, but the results were not satisfactory. Some scholars have also used intraoperative pumping method or intraoperative gastroscopic indication method to guide the degree of lower esophageal sphincter dissection [12], but it is not precise and difficult to accurately measure the length of lower esophageal sphincter dissection. intraoperative esophageal manometry (IEM) was first applied to pancreatic dystocia by Del et al. by measuring intraoperative The intraoperative lower esophageal sphincter pressure changes were used to determine whether the sphincter dissection was complete to ensure relief of symptoms. It has rarely been reported in anti-reflux surgery and esophageal hiatal hernia repair. The intraoperative esophageal manometry has been applied to the short-loose Nissen procedure since 2002, and intraoperative monitoring of the lower esophageal sphincter pressure (LESP) and total length (LESL) has helped to accurately determine the tightness of the fundoplication suture during anti-reflux surgery and reduce postoperative complications. Postoperative reflux symptoms disappeared without dysphagia and with necessary physiological functions such as belching and vomiting. At postoperative follow-up, no lower esophageal strictures or recurrences were seen on X-ray imaging and gastroscopy, and the incidence of acid reflux as demonstrated by 24-hour PH monitoring was only 5,9%. This is a significant improvement compared to 14,3% in the typical Nissen group and 11,7% in the short-loose Nissen group. The prior results were published in the Chinese Journal of Surgery. On the basis of this, in 2005, through the exchange with Krasna, a famous American thoracic surgeon, the necessity of esophageal manometry in the repair of hiatal hernia, especially in minimally invasive lumpectomy, became more evident. He added esophageal manometry to the anti-reflux surgery and esophageal hiatal hernia repair in the next 9 patients, and achieved very good results. We published our technique in “Disease of the Esophagus” (SCI Impact Factor 0, 936), and since early 2007, we have continued to explore the use of intraoperative esophageal manometry in anti-reflux surgery and esophageal hiatal hernia repair, and have begun to experiment with its use in a modified version of the Heller procedure. Heller procedure for the treatment of achalasia of the cardia. During the procedure, we not only monitored the change of pressure in the lower esophagus, but also helped to accurately measure the length of the myotomy of the lower esophagus. To further track the long-term outcome of the surgery for benign lower esophageal disease, expand the in-depth study of postoperative esophageal kinetic changes and develop criteria for monitoring the lower esophageal sphincter pressure and length during surgery for benign lower esophageal disease in order to improve the surgical technique for benign lower esophageal disease, ensure surgical outcomes, and reduce postoperative complications.