Objective. Studying of possibility of application of a self-fixing mesh ProGrip™ while plasty performing for large hiatal hernias (HH).Маterials and methods. In the investigation 144 patients, ageing 30 – 78 yrs old, owing HH with square 10 - 20 сm2, took part. The patients were divided into two groups. Group I consisted of 71 patients, to whom crurorhaphy with additional strengthening of the sutures, using a self-fixing mesh ProGrip™ was peformed. Group II consisted of 73 patients, in whom sutures of crurorhaphy were not strengthened by the mesh implant. Dynamical follow-up in patients was conducted in 3, 6, 12, 24, 36, 48 and 60 mo after the surgical treatment.Results. Average duration of the operation in patients of Group i and Group II did not differ essentially – (94 ± 12) and (92 ± 15) min, accordingly (p > 0.1). In late terms of follow-up the HH recurrence have occurred in 3.2% in the Group I patients and in 21.5% - in the Group II patients. The quality of life index in patients of Group I, in accordance to questionnaire SF-36, was trustworthily better, than in patients of Group II (p < 0.05).Conclusion. The mesh ProGrip™ application while doing plasty of large HH permits to lower the recurrence rate significantly and to improve the operative interventions results essentially.

Ðåôåðàò Ìåòà. Âñòàíîâëåííÿ åôåêòèâíîñò³ õ³ðóð´³÷íîãî ë³êóâàííÿ öóêðîâîãî ä³àáåòó ²² òèïó øëÿõîì âèêîíàííÿ òðóá-÷àñòî¿ ðåçåêö³¿ øëóíêó ³ç ÷àñòêîâèì â³äêëþ÷åííÿì ÄÏÊ (SG + TB). Ìàòåð³àë ³ ìåòîäè. Çà ïåð³îä â³ä 2014 äî 2018 ìè âèêîíàëè 12 îïåðàö³éíèõ âòðó÷àíü çà ñïðîùåíèì ìåòîäîì SG+TB ïàö³ºíòàì ³ç ìîðá³äíèì îaeèð³ííÿì òà öóêðîâèì ä³àáåòîì ²² òèïó. Íîâèé ìåòîä ïîëÿãຠó ïåðøî÷åðãîâîìó âèêîíàíí³ òðóá÷àñòî¿ ðåçåêö³¿ øëóíêó òà íàêëàäàíí³ îäíîãî àíàñòîìîçó ì³ae øëóíêîì òà êëóáîâîþ êèøêîþ. Ðåçóëüòàòè é îáãîâîðåííÿ. Óñêëàäíåíü âíàñë³äîê âèêîíàííÿ îïåðàö³éíèõ âòðó÷àíü íå áóëî. Âïðîäîâae ðîêó ó 4 ïàö³ºíò³â ³íäåêñ ìàñè ò³ëà çíèçèâñÿ â³ä ð³âíÿ 40-50 ê´/ì 2 äî 28-33 ê´/ì 2 , ó 3 õâîðèõ-â³ä ð³âíÿ >50 ê´/ì 2 äî 20,5-34,0 ê´/ ì2 òà ó äâîõ ³ç ïîêàçíèêàìè 35 ê´/ì 2 ïåðåä îïå-ðàö³ºþ, äî 23,5 ³ 26,0 ê´/ì 2 ÷åðåç ð³ê. Ïðàêòè÷íî â óñ³õ õâîðèõ ñïîñòåð³ãàëè ÷àñòêîâó àáî ïîâíó ðåì³ñ³þ öóêðîâîãî ä³àáåòó ²² òèïó. гâåíü ´ëþêîçè êðîâ³ õâîðèõ çìåíøèâñÿ â³ä ð³âíÿ 13-23 ììîëü/ë äî 4,5-8 ììîëü/ë, ´ë³êîçèëüîâàíèé ãåìî´ëîá³í-äî 5,4-6,8%. Âèñíîâîê. Ìîäèô³êîâàíèé ìåòîä SG+TB ³ç íàêëàäàííÿì îäíîãî øëóíêîâî-êèøêîâîãî àíàñòîìîçó º åôåêòèâíèì îïåðàö³éíèì âòðó÷àííÿì ïðè ë³êóâàíí³ öóêðîâîãî ä³àáåòó ²² òèïó. Äëÿ ï³äòâåðäaeåííÿ äîö³ëüíîñò³ âèêîíàííÿ òàêèõ îïåðàö³é íåîáõ³äíèì º ïðîâåäåííÿ ïîäàëüøèõ äîñë³äaeåíü.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Background: According to recent studies, large hiatal hernias (HH) can be associated with a lower content of type-I and type-III collagen in the phrenoesophageal ligament (POL). We therefore hypothesize that the use of a mesh implant with autologous platelet-rich plasma (PRP) for repair of large HH would have a positive effect on longterm outcome. The purpose of our study was to determine the level of type-I and type-III collagens in the POL of patients with large HH with the aim of improving the technique of HH repair. Materials and Methods:During the first phase of the study, the collagen content within the POL was assessed in 18 patients with HH and 14 cadaveric specimens without HH. During the second phase, 54 patients with large HH (defined as 10 to 20 cm 2 ), that required surgery were recruited. Laparoscopic repair involved use of a nonabsorbable self-fixating ProGrip mesh infiltrated with 2 to 4 mL of autologous PRP was used for reinforcement of crural repair. Results were assessed using endoscopy, barium swallow, 24-hour impedance-pH monitoring and a quality of life gastroesophageal reflux diseasehealth related quality of life questionnaire. Results:The content of collagen within POL in patients with HH was significantly lower than in the cadaveric specimens without HH. Of the 54 patients undergoing HH repair, all procedures were performed laparoscopically and there were no mortalities in this group. At 48 months, only 2 HH recurrences (3.7%) were detected. During this period, the mean gastroesophageal reflux disease-health related quality of life score decreased from 15.7 ± 5.5 to 5.9 ± 0.6 (P < 0.05). Conclusion:Our study has shown that the collagen content is reduced in patients with large HH; thus, it is advisable to use mesh for HH repair in such patients. Use of mesh infiltrated in PRP is safe and can have positive impact on results of HH repair.

Background: Different techniques of wrap fixation in laparoscopic Nissen fundoplication (LNF) have been proposed with of the aim to reduce the complications, but the optimal technique is yet to be determined. The aim of our prospective study was to evaluate several techniques of wrap fixation and determine whether the application of a combined approach to perform wrap fixation reduces the failure rate in short-term and long-term follow-up.Materials and Methods: One hundred two patients with sliding or paraesophageal hiatal hernia (type I or type II), who underwent antireflux surgery were randomized into 2 groups. In group I, LNF was supplemented with suturing the wrap to the diaphragmatic crura (35 patients) or to the body of stomach (16 patients). This was dependent on the strength of the crura (defined as weak or strong). The control group (51 patients) underwent LNF without wrap fixation. All patients were assessed using a validated symptom and quality of life (gastroesophageal reflux disease-Health Related Quality of Life) questionnaire, 24-hour impedance-pH monitoring, and barium swallow.Results: At the 48-month follow-up, the overall rate of complications was not significantly different between the 2 groups; however, there was a tendency toward a lower frequency of reoperations in the first group (P = 0.059). Fixation of the fundoplication of wrap was noted to lead to significantly lower rates of postoperative dysphagia (P < 0.05). These patients (group I) were also found to have significant improvement in gastroesophageal reflux disease-Health Related Quality of Life score (from 19.3 ± 13.2 to 4.3 ± 3.9 vs. from 18.7 ± 11.9 to 9.3 ± 7.7). Conclusion:Fixation of the Nissen fundoplication wrap has been shown to have a positive impact on the reduction of postoperative dysphagia and leads to an improvement in disease-specific quality of life.

Мета роботи: порівняння ефективності консервативної терапії та хірургічного лікування пацієнтів з респіраторними проявами гастроезофагеальної рефлюксної хвороби та грижами стравохідного отвору діафрагми.Матеріали і методи. 41 пацієнту було виконано лапароскопічні фундоплікації за Ніссеном та 25 пацієнтам проведено консервативну терапію гастроезофагеальної рефлюксної хвороби. Результати лікування оцінено за допомогою цілодобового рН- моніторингу стравоходу та опитувальника якості життя GERD-HRQL. Також виконували визначення інтенсивності печії за шкалою Likert, інтенсивності нападу кашлю за даними 10-бальної візуальної аналогової шкали, кількісного показника нападів кашлю впродовж однієї доби, індексу симптому рефлюксного кашлю.Результати досліджень та їх обговорення. Встановлено достовірно кращий результат (р < 0,001) відносно зменшення частоти та інтенсивності кашлю у хворих, яким виконували лапароскопічні фундоплікації. Регрес типової симптоматики також був кращим (р < 0,001) у хворих, яким проводились хірургічні втручання.

У 10% пацієнтів при гастроезофагеальній рефлексній хворобі (ГЕРХ) відсутні типові прояви захворювання, а основні симптоми виявляють у дихальній, серцево–судинній системах, ЛОР–органах. Мета. Покращення діагностичного алгоритму при виявленні позастравохідних проявів ГЕРХ; встановлення ефективності лапароскопічної фундоплікації у хворих за різних видів гастроезофагеального рефлюксу (ГЕР). Матеріали і методи. З використанням опитувальників якості життя (ЯЖ) SF–36 та GERD–HRQL оцінювали віддалені результати консервативної терапії та хірургічного лікування пацієнтів за наявності респіраторних та ЛОР проявів ГЕРХ. Результати. Більш суттєве покращення фізичного та психологічного компонентів ЯЖ відзначене у хворих, яким виконували лапароскопічну фундоплікацію. За опитувальником GERD–HRQL, ЯЖ хворих пысля хірургічного лікування покращилась через 6 міс – з (16,4 ± 5,3) до (6,2 ± 0,6) бала (р < 0,001), через 12 міс – до (6,4 ± 0,8) бала (р < 0,001); після консервативної терапії через 6 міс – з (15,9 ± 6,6) до (9,2 ± 1,9) бала (р < 0,001), через 12 міс – до (11,4 ± 1,5) бала (р < 0,05). Висновки. Лапароскопічна фундоплікація порівняно з консервативною терапією більш ефективний метод лікування пацієнтів за наявності позастравохідних проявів ГЕРХ.

Summary. The purpose was to study the features and results of redo laparoscopic antireflux surgery in our clinic. Materials and methods. For the period from 2008 to 2019, in our clinic, laparoscopic antireflux operations were performed in 1164 patients. 54 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n = 38), recurrent reflux (n = 4), dysphagia (n = 8), severe pain (n = 5). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. Results. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11 % of patients. Long-term follow up from 6 months to 6 years was observed in 90.74 % of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p <0.001). Good results were observed in 91.84 % of patients after redo operations. The third operation was needed in 5.6 % of patients. Conclusion. Redo laparoscopic antireflux operations are technically difficult surgical interventions, and should be performed by surgeons with big experience in the antireflux surgery. Laparoscopic antireflux surgery provide good long-term results in 90 % of patients.