Complications and relapses after alloplasty of large and giant hernia of the esophageal aperture of the diaphragm

Abstract

The review of the literature presents the content analysis of surgical treatment of large and giant hernia of the esophageal aperture of the diaphragm as well as the analyses of complications when using the main methods of hernioplasty. Alloplasty of the esophageal aperture of the diaphragm remains a large and unresolved surgical problem, as evidenced by the analyzed literature sources, mainly reviews and clinical recommendations.Firstly, alloplasty can cause postoperative complications with a frequency of up to 20%, especially when using rigid polypropylene and composite polytetrafluoroethylene mesh implants with circular paraesophageal fixation. Modern biological nets now show high incidence of anatomical relapses, so most specialists continue to use synthetic implants, of which the most promising ones are lightweight, mesh, partially absorbable structures.Secondly, clear indications for alloplasty have not been developed, for example, according to the size of the hernia of the esophageal opening in the diaphragm, which is the main risk factor for relapses.Thirdly, it is still not clear what indicator should be used to estimate the size of hernia of the esophageal aperture of the diaphragm and, therefore, it is not clearly defined which hernias are considered small, which are large and which are giant, despite the fact that the three terms constantly appear in the medical literature.Fourthly, the optimal technique for alloplasty has not been determined with large and especially giant hernias, which would prevent anatomical relapses, and at the same time would not cause postoperative complications.It is necessary to outline the following ways to solve these problems: to develop effective and at the same time safe methods of alloplasty of large and giant hernias; to determine clear indications for alloplasty of the esophageal opening of the diaphragm, depending on the size of hernias; to create an appropriate, applied classification of hernias of the esophageal aperture of the diaphragm.