Differentiated approach to the choice of plastic surgery for hiatal hernia

Cherkasov, D.M.; Черкасов, М. Ф.; Tatyanchenko, V.K.; Startsev, Yu. M.; Melikova, S.G.; Galashokyan, K.M.

doi:10.17116/endoskop2020260115

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Разработка и появление большого количества оперативных методик по коррекции РЭ и ГДС так и не привели к выработке единой тактики в хирургическом лечении этой патологии. Это связано с неудовлетворительными результатами как в ближайший, так и в отдаленном послеоперационном периоде [5,6,7]. При обсуждении современных методов хирургической коррекции РЭ во главу угла ставится, прежде всего, восстановление функционального состояния пищеводно-желудочного перехода создание антирефлюксного барьера.…”

Section: актуальностьunclassified

To the question of surgical correction of evacuatory disturbances of upper part of the gastrointestinal tract

Галимов

Khanov

Сатаев

et al. 2023

jour

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Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results.Materials and methods: 52 patients who underwent laparoscopic correction of hiatal hernia were examined.Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

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Section: актуальностьunclassified

To the question of surgical correction of evacuatory disturbances of upper part of the gastrointestinal tract

Галимов

Khanov

Сатаев

et al. 2023

jour

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The Lifetime Morphometry of Cardioesophageal Transition in Patients With Hiatal Hernia

et al. 2022

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With the development of X-ray technology and the advent of computed tomography, it became possible not only to accurately diagnose hiatal hernia, but also to conduct morphometry of all its constituent anatomical structures in different projections to use the data obtained at the stage of preoperative planning for its surgical treatment. Currently, due to the improvement in the quality of diagnostics, there is an increase in the detection of patients with this pathology, along with this, the question of choosing the most rational method of treatment is acute. The aim of the study was to study the computed tomographic anatomy of the structures of the cardioesophageal junction in patients with hiatal hernia. A retrospective study of a series of computed tomograms in 53 patients with hiatal hernia, performed on a 64-slice Canon Aquilion Prime tomograph, was carried out. An assessment was made of the diameter of the distal esophagus, the size of the hernia orifice, and the deviation of the axis of the esophagus at the level of the hernial orifice relative to the diaphragm in two planes. As a result of the analysis, it was found that in 79% of cases the esophagus was located on the right and behind the hernial sac, in 13% - behind and in the middle, in 8% - on the left and behind. It was revealed that the diameter of the unchanged part of the esophagus above the hernial sac was 20.9±3.71 mm (min – 15.7 mm, max – 30.2 mm). The dimensions of the hernial orifice varied within 31.21±5.23 mm in the frontal plane (min - 24.7 mm, max - 42 mm) and 32.66±4.36 mm in the sagittal plane (min - 26.2 mm, max - 39.1 mm). The deviation of the axis of the esophagus in the frontal plane was 63.53°±16.74 (min - 19.6°, max - 92.3°). The deviation of the axis of the esophagus in the sagittal plane was 74.12°±21.31 (min - 36.3°, max - 118.1°). Thus, due to the variability in the structure and location of the anatomical structures of the cardioesophageal zone in patients with hiatal hernia, it is necessary to take into account all of the above indicators, including the presence or absence of large branches of the greater omentum in the hernial sac, body type, gender, age of patients, which serves an integral part of preoperative planning of surgical treatment, optimization and reduction of complications, as well as determining the safest method of its surgery.

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Complications of surgical treatment of hiatal hernia and tactics of its elimination: An observational non-randomized study

Kolesnikov,

Bugaev,

Bugaeva

et al. 2024

Kuban. nauсh. med. vestnik

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Background. An introduction of minimally invasive technologies contributes to annual increase in the number of surgical interventions for hiatal hernia. However, the rate of major complications (pain syndrome, dysphagia and recurrence of gastroesophageal reflux) inevitably reaches 32%. 19% of the patients need re-surgery, 60‒70% of them fail to recover, and 45% undergo surgical interventions for the third time.Aim. To specify the major complications of surgical treatment for hiatal hernia and to substantiate the optimal techniques of reconstructive interventions for its elimination.Methods. An observational non-randomized study involved 78 patients diagnosed with hiatal hernia without obstruction or gangrene. Patients were categorized into three groups depending on the performed surgical intervention — primary or reconstructive. Group 1 included 31 patients who underwent surgical treatment by means of traditional tactics and techniques (Nissen, Dor procedures); Group 2 enrolled 35 patients after incomplete selective proximal vagotomy with fundoplication according to Chernousov; Group 3 consisted of 12 patients who underwent reconstructive re-surgey for complications of surgical treatment of hiatal hernia. Surgical interventions were performed in five city and district general surgical hospitals of Belgorod Oblast, Russia. The hospitals were considered equally equipped and had surgeons of similar qualification. Patients were included in the study from 2015 to 2023, the follow-up of each patient lasted from 3 months to 8 years. The results of surgical treatment were evaluated by a questionnaire survey. Presence and severity of the major complications of surgical treatment for hiatal hernia were assessed according to the Dakkak scale and Gastro Esophageal Reflux Disease (GERD) questionnaire, evaluating patient outcomes as excellent, good, satisfactory, and unsatisfactory. Statistical data processing was carried out by means of Microsoft Excel 2019 (Microsoft, USA). A statistical level with p ≤ 0.05 was considered statistically significant.Results. The major complications of surgical interventions for hiatal hernia include recurrence of gastroesophageal reflux, pain syndrome and dysphagia, which made up 54.8, 48.4 and 61.3% in Group 1, respectively. In total, the shares of all types of complications exceed 100%, as three patients were recorded with all three complications, 12 patients — with two types of complications, and 15 patients had one complication. The results evaluating the patient’s condition were expressed as good in 19.4% of patients, satisfactory — in 22.6%, and unsatisfactory — in 58.0%. In Group 2, the results evaluating the patient’s condition appeared only good (22.9%) and excellent (77.1%). The reconstructive interventions in Group 3 included: elimination of cruroraphia; incomplete selective proximal vagotomy with modified gastroesophageal refundoplication and fundoplication according to Chernousov; formation of the esophageal hiatus in the diaphragm adequate to the parameters of the fundoplication cuff. The results evaluating the patient’s condition appeared only good (22.2%) and excellent (77.8%).Conclusion. The major complications of surgical treatment for hiatal hernia include pain syndrome, dysphagia and recurrence of gastroesophageal reflux and can be eliminated by the reconstructive interventions composed of the following techniques: elimination of cruroraphia, removal of the cuff, incomplete selective proximal vagotomy, refundoplication by the modified method according to Chernousov, formation of the esophageal hiatus in the diaphragm with adequate parameters of the fundoplication cuff.

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Differentiated approach to the choice of plastic surgery for hiatal hernia

Cited by 3 publications

References 6 publications

To the question of surgical correction of evacuatory disturbances of upper part of the gastrointestinal tract

To the question of surgical correction of evacuatory disturbances of upper part of the gastrointestinal tract

The Lifetime Morphometry of Cardioesophageal Transition in Patients With Hiatal Hernia

Complications of surgical treatment of hiatal hernia and tactics of its elimination: An observational non-randomized study

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