The original method of surgical treatment of large and giant hiatal hernia
Abstract
Relevance. Nowadays the treatment of large and giant hiatal hernia occurring in 5–7% of patients, is an urgent problem in esophagus surgery. Since 2000, for plastics of diaphragm, in case of hiatal hernia, mesh implants are being used. An important point of their use is to reduce the risk of specific complications, such as erosion, pressure ulcers and perforations of the esophagus and stomach.
The aim of our work is вместо тире improvement of the outcomes of surgical treatment of patients with large and giant hiatal hernia by using the original technique of setting and fixing the mesh implant with the plastic of the esophageal hiatus.
Study design – prospective, level of evidence II.
Material and methods. We present the experience of surgical treatment of 23 patients with large and giant hiatal hernia who underwent laparoscopic interventions according to the original technique. The essence of the original technique was the method of plastic esophageal hiatus: the mesh implant of rectangular shape was cut out, settled in the posterior mediastinum above the diaphragm, so that the long side of the implant was at a distance of at least 2 cm from the back wall of the esophagus, and the surface of the implant covered the esophageal hiatus and the crura of diaphragm. The mesh implant was fixed at its corners to the diaphragm. After that, posterior cruroraphy was performed, so that last suture on crus of diaphragm laid above the implant.
Results. The average duration of the operation was 142 min, of which the time of fixing the mesh implant was from 23 to 35 min. Intraoperative bleeding was noted in 2 (10.7%) patients, in connection with the expressed adhesive process, which did not require conversion. In the near postoperative period, no complications were noted. The postoperative stay was 5.2±0.7 days. In the long-term periods from 1 to 5 years, none of the patients who underwent surgical treatment according to the claimed method were found to have recurrences of hiatal hernia and complications associated with the use of mesh implants.
Conclusions. Laparoscopic treatment (Nissen or Nissen–Rosetti operation) are the surgical interventions of choice in the treatment of patients with large and giant hiatal hernia. The most effective method of surgery for large and giant hiatal hernia is the combined plastics of the esophageal hiatus by a mesh implant in combination with a posterior crural closure, with the setting and fixing the mesh implant in the posterior mediastinum above the diaphragm.
Keywords:giant hiatal hernia, mesh implant, plastic esophageal hiatus, hiatal surface area
Clin. Experiment. Surg. Petrovsky J. 2018; 6 (2): 26–31.
doi: 10.24411/2308-1198-2018-12003. Received: 11.07.2017. Accepted: 20.04.2018.
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