Currently, bariatric (metabolic) surgery is the main effective treatment of obesity and associated pathological conditions. The features of the course of obesity as a chronic progressive disease, heterogeneous etiology, clinical manifestations and a steady increase in number of patients worldwide make the problem of bariatric interventions extremely urgent. The article presents the analysis of modern data concerning the choice of the method of surgical benefits in patients with obesity and their own clinical experience.
To treat the patient with Achalasia and prevent the symptoms of gastroesophageal reflux the Peroral Endoscopic Myotomy with Simultaneous Endoscopic Fundoplication was done by the current authors. After performing a myotomy the endoloop was fixated to the stomach and was attached to the muscle of the esophagus by using the endoclips. The endoloop was tightened therefore shaping the cuff. This operation has been technically feasible and no immediate or delayed complications occurred.
Surgical treatment of obesity and associated diseases, like any other field of practical medicine, is based on certain laws and conditions. All the principles of bariatric surgery were formulated in the process of accumulating a positive and negative experience of using various surgical interventions. The article presents an historical perspective on the evolution of views on the fundamental principles of the operative treatment of obesity and associated diseases.
Celiac trunk compression syndrome is a symptom complex arising from compression of the celiac trunk by the median arcuate ligament, crura of diaphragm or ganglion tissue of the celiac plexus. The main clinical manifestations of this pathological condition are abdominal pain syndrome, indigestion and weight loss. The disease is detected in 0.4–1 % of people in the population, more often in young people. The pathophysiological mechanisms of the development of celiac trunk compression syndrome remain not fully understood, but the key reason for its development is ischemia of the digestive system. The main instrumental methods for diagnosing compression of the celiac trunk are ultrasound duplex scanning of the abdominal aorta and visceral arteries and spiral computed angiography. The only effective treatment for celiac trunk compression syndrome is surgery. Currently, both classical techniques and various minimally invasive technologies are used to decompress the celiac trunk. The advantages of open access include good visual and manual control of anatomical structures, the possibility of eliminating complications, changing the tactics of surgical intervention, if necessary, performing vascular reconstruction. The advantage of minimally invasive surgical technologies is minimal trauma to the abdominal wall tissues, minor postoperative pain syndrome, early rehabilitation, a low risk of developing cusp, wound infection and hernial defects. Regardless of the methodology, surgical treatment can achieve a positive effect in 75–90 % of patients with celiac trunk compression syndrome. These are the modern concepts of epidemiology, pathogenesis, clinical manifestations, diagnosis and methods of treatment of this pathological condition.
OBJECTIVE. Hiatal hernias are the most common type of visceral anatomy disorder. The unresolved problem of surgical treatment of this pathology remains the high frequency of its relapse. Currently, it is believed that repeated surgical interventions for hiatal hernia are technically difficult, carry a high risk of complications and have unsatisfactory long-term results.MATERIAL AND METHODS. In the period from 2015 to 2019, 55 patients with this pathology were operated. In 52 (94.5 %) cases, the revision operation was performed laparoscopically, in 3 (5.5 %) – through left-side thoracotomy. The technique of the operation implied the removal of hiatal hernia and the implementation of antireflux reconstruction. In five (9.9 %) patients with a shortened esophagus, the fundoplication wrap was originally created in the chest; in 50 (90.1 %), normal anatomy was restored.RESULTS. Long-term results ranging from 12 to 48 months were evaluated in 53 (96.4 %) cases. The natural position of the esophagus and stomach in relation to the diaphragm was detected in 43 (81.1 %) patients, relapse of hiatal hernia – in 5 (9.4 %). In 5 patients, the fundoplication wrap formed in the chest was functional. The absence of gastroesophageal reflux was observed in 41 (91.8 % of patients who had GERD before surgery). In 4 (8.8 %) cases, including one patient with antireflux reconstruction in the chest, a relapse of the disease occurred.CONCLUSION. The presented results allowed the surgical treatment of recurrent hiatal hernias reasonable and effective.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.
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