Surgical Treatment of Recurrent Hiatal Hernias

Abstract

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.